超声引导下前锯肌平面阻滞用于乳腺手术后镇痛的疗效：随机对照试验的系统评价和荟萃分析。
Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
机构信息
Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Pain Res Manag. 2021 Oct 25;2021:7849623. doi: 10.1155/2021/7849623. eCollection 2021.
OBJECTIVE
Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery.
METHODS
A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations.
RESULTS
Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, -38.51 mg of oral morphine equivalent; 95% confidence interval (CI), -60.97 to -16.05; < 0.01; = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, -9.85 mg of oral morphine equivalent; 95% CI, -19.52 to -0.18; =0.05; = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19-0.55; < 0.05; = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), -1.23; 95% CI, -2.00 to -0.45; = 92%; 2 h: SMD, -0.71; 95% CI, -1.00 to -0.41; = 48%; 4 h: SMD, -1.52; 95% CI, -2.77 to -0.27; = 95%; 6 h: SMD, -0.80; 95% CI, -1.51 to -0.08; = 81%; 8 h: SMD, -1.12; 95% CI, -1.98 to -0.27; = 92%; 12 h: SMD, -0.78; 95% CI, -1.21 to -0.35; = 83%; and 24 h: SMD, -0.71; 95% CI, -1.20 to -0.23; = 87%; < 0.05 for all).
CONCLUSION
SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.
目的
胸长神经阻滞（SAPB）可提供有效的胸部镇痛。本系统评价和荟萃分析旨在评估 SAPB 在乳房手术后用于术后镇痛的安全性和有效性。
方法
使用 Embase、PubMed、Web of Science 和 Cochrane 图书馆对符合条件的随机对照试验进行系统文献检索。主要结局包括术中及术后阿片类药物的使用情况。采用推荐分级的评估、制定与评价（GRADE）方法对推荐意见的证据质量进行评级。
结果
共有 13 项研究（826 例患者）符合纳入标准（SAPB 组 412 例，对照组 414 例）。SAPB 组患者术后阿片类药物的使用量明显减少（口服吗啡等效物的平均差值为-38.51mg；95%置信区间（CI）为-60.97 至-16.05；<0.01； = 100%），而术中阿片类药物的使用量无差异（口服吗啡等效物的平均差值为-9.85mg；95%CI 为-19.52 至-0.18；=0.05； = 94%）。此外，SAPB 还显著降低了术后恶心和呕吐的发生率（风险比为 0.32；95%CI 为 0.19-0.55；<0.05； = 38%），并降低了术后各时间点的疼痛评分（1 小时：标准化均数差（SMD）为-1.23；95%CI 为-2.00 至-0.45； = 92%；2 小时：SMD 为-0.71；95%CI 为-1.00 至-0.41； = 48%；4 小时：SMD 为-1.52；95%CI 为-2.77 至-0.27； = 95%；6 小时：SMD 为-0.80；95%CI 为-1.51 至-0.08； = 81%；8 小时：SMD 为-1.12；95%CI 为-1.98 至-0.27； = 92%；12 小时：SMD 为-0.78；95%CI 为-1.21 至-0.35； = 83%；24 小时：SMD 为-0.71；95%CI 为-1.20 至-0.23； = 87%；<0.05 均）。
结论
SAPB 用于乳房手术后可安全有效地缓解术后疼痛，但还需要进一步开展设计完善的试验来验证这些发现。
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