Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
J Clin Anesth. 2021 Sep;72:110274. doi: 10.1016/j.jclinane.2021.110274. Epub 2021 Apr 16.
Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to compare the efficacy and side effects of different analgesic strategies in breast surgery.
Systematic review and network meta-analysis.
Operating room, postoperative recovery room and ward.
Patients scheduled for breast surgery under general anesthesia.
Following an extensive search of electronic databases, those who received any of the following interventions, control, local anesthetic (LA) infiltration, erector spinae plane (ESP) block, pectoralis nerve (PECS) block, paravertebral block (PVB) or serratus plane block (SPB), were included. Exclusion criteria were met if the regional anesthesia modality was not ultrasound-guided. Network plots were constructed and network league tables were produced.
Co-primary outcomes were the pain at rest at 0-2 h and 8-12 h. Secondary outcomes were those related to analgesia, side effects and functional status.
In all, 66 trials met our inclusion criteria. No differences were demonstrated between control and LA infiltration in regard to the co-primary outcomes, pain at rest at 0-2 and 8-12 h. The quality of evidence was moderate in view of the serious imprecision. With respect to pain at rest at 8-12 h, ESP block, PECS block and PVB were found to be superior to control or LA infiltration. No differences were revealed between control and LA infiltration for outcomes related to analgesia and side effects, and few differences were shown between the various regional anesthesia techniques.
In breast surgery, regional anesthesia modalities were preferable from an analgesic perspective to control or LA infiltration, with a clinically significant decrease in pain score and cumulative opioid consumption, and limited differences were present between regional anesthetic techniques themselves.
在接受乳房手术的女性中，多达 60%的人会出现中度至重度术后疼痛。我们的目的是进行网络荟萃分析和系统评价，以比较不同镇痛策略在乳房手术中的疗效和副作用。
系统评价和网络荟萃分析。
手术室、术后恢复室和病房。
接受全身麻醉下乳房手术的患者。
在广泛搜索电子数据库后，纳入接受以下任何干预措施的患者：对照组、局部麻醉（LA）浸润、竖脊肌平面（ESP）阻滞、胸肌神经（PECS）阻滞、肋间神经阻滞（PVB）或锯状肌平面阻滞（SPB）。如果区域麻醉方式不是超声引导，则排除在外。构建网络图并制作网络联盟表。
主要结局是 0-2 小时和 8-12 小时静息时的疼痛。次要结局是与镇痛、副作用和功能状态相关的结局。
共有 66 项试验符合我们的纳入标准。在主要结局（0-2 小时和 8-12 小时静息时的疼痛）方面，对照组和 LA 浸润组之间没有差异。考虑到严重的不精确性，证据质量为中等。就 8-12 小时静息时的疼痛而言，ESP 阻滞、PECS 阻滞和 PVB 优于对照组或 LA 浸润。对照组和 LA 浸润在与镇痛和副作用相关的结局方面没有差异，并且各种区域麻醉技术之间也没有显示出显著差异。
在乳房手术中，与对照组或 LA 浸润相比，区域麻醉方法在镇痛方面更具优势，疼痛评分和累积阿片类药物消耗均有显著下降，并且区域麻醉技术本身之间的差异有限。
