Kalthoff Andrew, Sanda Milo, Tate Patrick, Evanson Kirk, Pederson John M, Paranjape Geeta S, Patel Puja D, Sheffels Erin, Miller Richard, Gupta Anil
Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, Ohio, U.S.A..
Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, Ohio, U.S.A.
Arthroscopy. 2022 May;38(5):1627-1641. doi: 10.1016/j.arthro.2021.11.054. Epub 2021 Dec 21.
The purpose of this review is to compare the effectiveness of different peripheral nerve blocks and general anesthesia (GA) in controlling postoperative pain after arthroscopic rotator cuff repair (ARCR).
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted for the period of January 1, 2005, to February 16, 2021, by searching the following databases: PubMed, Cochrane, Embase, and Arthroscopyjournal.org. The primary outcomes of interest included 1-hour, 24-hour, and 48-hour pain scores on a numeric rating scale or visual analog scale (VAS). Inclusion criteria were English language studies reporting on adults (≥18 years) undergoing ARCR with peripheral nerve blockade. To synthesize subjective pain score data at each evaluation time point across studies, we performed random-effects network meta-regression analyses accounting for baseline pain score as a covariate.
A total of 14 randomized controlled trials with 851 patients were included in the meta-analysis. Data from six different nerve block interventions, single-shot interscalene brachial plexus nerve block (s-ISB; 37.8% [322/851]), single-shot suprascapular nerve block (s-SSNB; 9.9% [84/851]), continuous ISB (c-ISB; 17.5% [149/851]), continuous SSNB (c-SSNB; 6.9% [59/851]), s-ISB combined with SSNB (s-ISB+SSNB; 5.8% [49/851]), s-SSNB combined with axillary nerve block (s-SSNB+ANB; 4.8% [41/851]), as well as GA (17.3% [147/851]) were included. Our meta-analysis demonstrated that c-ISB block had a significant reduction in pain score relative to GA at 1-hour postoperation (mean difference [MD]: -1.8; 95% credible interval [CrI] = -3.4, -.08). There were no significant differences in VAS pain scores relative to GA at 24 and 48 hours postoperatively. However, s-ISB+SSNB had a significant reduction in 48-hour pain score compared to s-ISB (MD = -1.07; 95% CrI = -1.92, -.22).
It remains unclear which peripheral nerve block strategy is optimal for ARCR. However, peripheral nerve blocks are highly effective at attenuating postoperative ARCR pain and should be more widely considered as an alternative over general anesthesia alone.
Level II Systematic review and meta-analysis of Level I and II studies.
本综述旨在比较不同外周神经阻滞与全身麻醉（GA）在关节镜下肩袖修复术（ARCR）后控制术后疼痛方面的有效性。
对2005年1月1日至2021年2月16日期间进行了一项符合系统评价与Meta分析的首选报告项目标准的系统评价，通过检索以下数据库：PubMed、Cochrane、Embase和Arthroscopyjournal.org。感兴趣的主要结局包括数字评分量表或视觉模拟量表（VAS）上的1小时、24小时和48小时疼痛评分。纳入标准为报告≥18岁成人接受ARCR并进行外周神经阻滞的英文研究。为了综合各研究在每个评估时间点的主观疼痛评分数据，我们进行了随机效应网络Meta回归分析，并将基线疼痛评分作为协变量。
Meta分析共纳入14项随机对照试验，涉及851例患者。数据来自六种不同的神经阻滞干预措施，单次肌间沟臂丛神经阻滞（s-ISB；37.8%[322/851]）、单次肩胛上神经阻滞（s-SSNB；9.9%[84/851]）、连续肌间沟阻滞（c-ISB；17.5%[149/851]）、连续肩胛上神经阻滞（c-SSNB；6.9%[59/851]）、s-ISB联合SSNB（s-ISB+SSNB；5.8%[49/851]）、s-SSNB联合腋神经阻滞（s-SSNB+ANB；4.8%[41/851]），以及GA（17.3%[147/851]）。我们的Meta分析表明，c-ISB阻滞在术后1小时相对于GA疼痛评分显著降低（平均差[MD]：-1.8；95%可信区间[CrI]=-3.4，-0.08）。术后24小时和48小时相对于GA的VAS疼痛评分无显著差异。然而，与s-ISB相比，s-ISB+SSNB在48小时疼痛评分上显著降低（MD=-1.07；95%CrI=-1.92，-0.22）。
目前尚不清楚哪种外周神经阻滞策略对ARCR最为理想。然而，外周神经阻滞在减轻ARCR术后疼痛方面非常有效，应更广泛地被视为单独全身麻醉的替代方法。
I级和II级研究的II级系统评价和Meta分析。
