Weng Wei-Teng, Wang Chi-Jane, Li Chung-Yi, Wen Huai-Wei, Liu Yen-Chin
Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan.
Pain Physician. 2021 May;24(3):203-213.
Erector spinae plane block could be a potential alternative to paravertebral block or other analgesic techniques for breast surgery, but the current evidence on erector spinae plane block in breast surgery is conflicting.
To compare the analgesic effectiveness between erector spinae plane block, systemic analgesic, and paravertebral block for breast surgery.
Meta-analysis.
The literature search was performed from 2016 to August 2020 using the MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases.
Clinical trials comparing erector spinae plane block to systemic analgesic and paravertebral block were included from the aforementioned databases. Primary outcomes were 24-hour postoperative opioid administration and postoperative pain score. Secondary outcomes were patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related side effects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysis were performed according to the PRISMA statement.
We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemic analgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperative intravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Compared with paravertebral block, no statistical difference was found in opioid administration. No differences were observed in pain score, opioid-related side effects, or analgesic technique-related complications. Between the trials, heterogeneity existed and could not be evaluated using meta-regression owing to inadequate reported data.
Moderate heterogeneity among the included trials could not be assessed by potential covariates owing to the limited reported data in each trial.
Erector spinae plane block is superior to systemic analgesic within 24 hours after breast surgery and can serve as an alternative to paravertebral block with similar analgesic effects.
竖脊肌平面阻滞可能是乳房手术椎旁阻滞或其他镇痛技术的一种潜在替代方法，但目前关于竖脊肌平面阻滞用于乳房手术的证据存在矛盾。
比较竖脊肌平面阻滞、全身镇痛和椎旁阻滞用于乳房手术的镇痛效果。
荟萃分析。
于2016年至2020年8月使用MEDLINE、EMBASE、Cochrane图书馆和ClinicalTrials.gov数据库进行文献检索。
从上述数据库中纳入比较竖脊肌平面阻滞与全身镇痛和椎旁阻滞的临床试验。主要结局为术后24小时阿片类药物用量和术后疼痛评分。次要结局为患者满意度、麻醉后护理单元和住院时间、阻滞相关副作用和阿片类药物相关副作用。根据PRISMA声明进行系统检索、严格评价和汇总分析。
我们分析了8项随机对照试验中的495例病例。与全身镇痛相比，使用竖脊肌平面阻滞导致术后24小时静脉注射吗啡等效剂量平均减少7.59mg（P<0.00001）。与椎旁阻滞相比，阿片类药物用量无统计学差异。在疼痛评分、阿片类药物相关副作用或镇痛技术相关并发症方面未观察到差异。各试验之间存在异质性，由于报告数据不足，无法使用Meta回归进行评估。
由于每个试验报告的数据有限，纳入试验之间的中度异质性无法通过潜在协变量进行评估。
竖脊肌平面阻滞在乳房手术后24小时内优于全身镇痛，可作为镇痛效果相似的椎旁阻滞的替代方法。
