髋关节镜手术中与局部麻醉相比，周围神经阻滞在疼痛管理方面没有任何临床优势：一项随机对照试验的荟萃分析。

Peripheral Nerve Block for Hip Arthroscopy Does Not Have any Clinical Advantage Compared With Local Anesthetic Regarding Pain Management: A Meta-analysis of Randomized Controlled Trials.

机构信息

Department of Anesthesia and Pain Medicine, Bio-medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea.

出版信息

Arthroscopy. 2022 Jun;38(6):2007-2017. doi: 10.1016/j.arthro.2021.12.011. Epub 2021 Dec 14.

DOI:10.1016/j.arthro.2021.12.011

PMID:34920002

Abstract

PURPOSE

To evaluate the efficacy of peripheral nerve block on reduction in opioid consumption and pain control after hip arthroscopy.

METHOD

To identify studies evaluating the effects of peripheral nerve block on pain control and reduction in opioid consumption in hip arthroscopy, we searched all records in the PubMed, Embase, and Cochrane Library databases until May 2021. Studies with the following characteristics were considered eligible: 1) patients who underwent a hip arthroscopy (population); 2) patients who received peripheral nerve block (intervention); 3) patients who did not receive peripheral nerve block (comparator); 4) record of total opioid consumption as a primary outcome and pain level at 1, 3 to 6, and 24 hours after surgery, patient satisfaction, and incidence of nausea and vomiting as secondary outcomes (outcomes); and 5) randomized controlled trial (study design). Data were independently extracted by two reviewers and synthesized using a random or fixed-effects model, according to the heterogeneity.

RESULTS

Eight RCTs were finally included in the meta-analysis. There were no significant differences in postoperative opioid consumption at 24 hours (standardized mean difference [SMD] = -0.091, 95% confidence interval [CI] [-0.270, 0.089]) or in visual analog scale (VAS) score at 1 (SMD = 0.299, 95% CI [-0.758, 0.160]), 3 to 6 (SMD = -0.304, 95% CI [-0.655, 0.047]), and 24 (SMD = -0.230, 95% CI [-0.520, 0.060]) hours postoperatively between the peripheral nerve block and control groups. Moreover, no significant differences were observed in patient satisfaction (SMD < 0.001, 95% CI [-0.284, 0.284]) or the incidence of nausea and vomiting (SMD = 0.808, 95% CI [0.311, 2.104]) between the two groups.

CONCLUSION

Peripheral nerve block for hip arthroscopy has no clinical advantage regarding pain management after surgery when compared with the group that received the local infiltration of analgesics without peripheral nerve block.

LEVEL OF EVIDENCE

Level II, meta-analysis of level I and II randomized controlled trials (RCTs).

摘要

目的

评估外周神经阻滞对髋关节镜术后减少阿片类药物消耗和控制疼痛的疗效。

方法

为了评估外周神经阻滞对髋关节镜术后疼痛控制和减少阿片类药物消耗的影响，我们检索了 PubMed、Embase 和 Cochrane 图书馆数据库中的所有记录，截至 2021 年 5 月。符合以下特征的研究被认为是合格的：1）接受髋关节镜检查的患者（人群）；2）接受外周神经阻滞的患者（干预）；3）未接受外周神经阻滞的患者（对照组）；4）以总阿片类药物消耗量为主要结局，以术后 1、3 至 6 和 24 小时的疼痛水平、患者满意度和恶心呕吐发生率为次要结局（结局）；5）随机对照试验（研究设计）。数据由两名评审员独立提取，并根据异质性使用随机或固定效应模型进行综合。

结果

最终纳入了 8 项 RCT 进行荟萃分析。术后 24 小时阿片类药物消耗（标准化均数差 [SMD] = -0.091，95%置信区间 [CI] [-0.270，0.089]）或术后 1 小时（SMD = 0.299，95% CI [-0.758，0.160]）、3 至 6 小时（SMD = -0.304，95% CI [-0.655，0.047]）和 24 小时（SMD = -0.230，95% CI [-0.520，0.060]）时，外周神经阻滞组与对照组之间的视觉模拟量表（VAS）评分无显著差异。此外，两组患者满意度（SMD < 0.001，95% CI [-0.284，0.284]）或恶心呕吐发生率（SMD = 0.808，95% CI [0.311，2.104]）无显著差异。