Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Translational Neuroscience Center, Sichuan University, Chengdu, Sichuan, China.
Paediatr Anaesth. 2021 Oct;31(10):1046-1055. doi: 10.1111/pan.14255. Epub 2021 Aug 2.
The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta-analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children.
We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed- or random-effects model, depending on whether the heterogeneity tested by the I statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method.
Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0 h (standardized mean difference [SMD]: -1.07; 95% confidence interval [CI]: -1.60 to -0.54; I = 52%), 6 h (SMD: -0.82; 95% CI: -1.39 to -0.25; I = 79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I = 16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block.
This review provides low-quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large-sized and well-designed randomized controlled trials are needed.
竖脊肌平面阻滞是一种新的区域麻醉技术，在儿科领域越来越受欢迎。然而，儿童中竖脊肌平面阻滞的效果尚不清楚。本系统评价和荟萃分析的目的是调查竖脊肌平面阻滞在儿童术后疼痛缓解中的作用。
我们检索了 MEDLINE、Cochrane 图书馆、EMBASE、中国知网和万方数据库，以比较接受手术的儿科患者接受竖脊肌平面阻滞与不阻滞或其他类型阻滞的随机对照试验。主要结局是术后 24 小时内静息时的疼痛强度和需要解救镇痛的患者人数。数据采用固定或随机效应模型进行分析，具体取决于 I ² 检验的异质性是否>30%。我们使用推荐评估、制定与评价（Grading of Recommendations, Assessment, Development, and Evaluation，GRADE）方法评估结局的证据质量。
共纳入 7 项随机对照试验，涉及 379 例患者。与不阻滞相比，竖脊肌平面阻滞在术后 0 小时（标准化均数差 [SMD]：-1.07；95%置信区间 [CI]：-1.60 至 -0.54；I ² = 52%）、6 小时（SMD：-0.82；95% CI：-1.39 至 -0.25；I ² = 79%）时静息时疼痛评分略有降低，且显著减少了对解救性镇痛的需求（比值比 0.09；95% CI：0.04 至 0.21；I ² = 16%）。一项试验表明竖脊肌平面阻滞的镇痛效果与腰方肌阻滞相似，另一项试验表明竖脊肌平面阻滞的镇痛效果优于髂腹股沟神经阻滞。
本综述提供了低质量证据，表明与不阻滞相比，竖脊肌平面阻滞在儿童中具有更好的镇痛效果。由于数据有限，关于与其他区域阻滞比较的证据仍不清楚。需要未来开展更大规模和精心设计的随机对照试验。
