胸椎手术和乳腺手术中椎旁阻滞与肋间神经阻滞的疗效和安全性：系统评价和荟萃分析。

Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis.

机构信息

Nanjing University of Chinese Medicine, Nanjing, Jangsu, China.

Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China.

出版信息

PLoS One. 2020 Oct 5;15(10):e0237363. doi: 10.1371/journal.pone.0237363. eCollection 2020.

OBJECTIVE

To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery.

METHODS

The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis.

RESULTS

A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02).

CONCLUSION

Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.

目的

评估胸椎手术和乳腺手术后椎旁阻滞（PVB）与肋间神经阻滞（INB）的镇痛效果和安全性。

方法

检索 PubMed、Web of Science、Embase 和 Cochrane Library 数据库，收集所有评估胸椎手术和乳腺手术后 PVB 与 INB 镇痛效果和安全性的随机对照试验（RCT）。对于二分类变量，采用比值比（OR）和 95%置信区间（CI）进行分析。对于连续性变量，采用加权均数差（WMD）和 95%置信区间（CI）进行分析。采用 RevMan5.3 和 Stata/MP 14.0 进行荟萃分析。

结果

共纳入 9 项研究，包括 440 例患者（PVB 组：222 例；INB 组：218 例）。主要结局指标显示，两组术后 1h（Std. MD=-0.20；95%CI=-1.11 to 0.71；P=0.66）、2h（Std. MD=-0.71；95%CI=-2.32 to 0.91；P=0.39）、24h（Std. MD=-0.36；95%CI=-0.73 to -0.00；P=0.05）和 48h（Std. MD=-0.04；95%CI=-0.20 to 0.11；P=0.57）的视觉模拟评分（VAS）差异无统计学意义。然而，非中文亚组在 1h（Std. MD=0.33；95%CI=0.25 to 0.41；P<0.00001）和中文亚组在 24h（Std. MD=-0.32；95%CI=-0.49 to-0.14；P=0.0003）的 VAS 差异有统计学意义。次要结局指标分析也显示，两组术后恶心呕吐发生率（OR=0.63；95%CI=0.38 to 1.03；P=0.06）和术后追加镇痛发生率（OR=0.57；95%CI=0.21 to 1.55；P=0.27）差异无统计学意义。术后吗啡消耗量（Std. MD=-14.57；95%CI=-26.63 to -0.25；P=0.02）差异有统计学意义。