Duan Mingda, Xu Yuhai, Fu Qiang
Department of Anesthesiology, Hainan Hospital of General Hospital of PLA, Sanya, China.
Department of Anesthesiology, Air Force Medical Center, Beijing, China.
Front Surg. 2022 Feb 28;9:845125. doi: 10.3389/fsurg.2022.845125. eCollection 2022.
Erector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.
A systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.
A total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD -2.76, 95% CI: -3.69, -1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD -5.08, 95% CI: -7.95, -2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD -1.62, 95% CI: -2.55, -0.69), 6 h (WMD -1.10, 95% CI: -1.45, -0.75), 12 h (WMD -0.78, 95% CI: -1.23, -0.32) and 24 h (WMD -0.54, 95% CI: -0.83, -0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.
ESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings. http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.
竖脊肌平面阻滞（ESPB）作为一种区域麻醉方式，正受到越来越多的关注，并已用于腹部、胸部和乳腺手术。关于这种阻滞在脊柱手术中的疗效证据尚不明确。最近发表的关于这个问题的综述在方法上存在相关局限性。
使用PubMed、Scopus、Embase和Cochrane对照试验中央注册库（CENTRAL）进行系统检索。纳入在接受脊柱手术的患者中进行的随机对照试验（RCT），这些试验比较了接受ESPB的患者和未接受阻滞/安慰剂的患者之间的相关结局。使用STATA软件进行统计分析。对汇总证据的质量进行GRADE评估。
共纳入13项研究。接受ESPB的患者总阿片类药物使用量显著减少（标准化均数差，SMD -2.76，95%可信区间：-3.69，-1.82），补救镇痛需求（相对危险度，RR 0.38，95%可信区间：0.22，0.66）和补救镇痛量（SMD -5.08，95%可信区间：-7.95，-2.21）。接受ESPB的患者术后1小时（加权均数差，WMD -1.62，95%可信区间：-2.55，-0.69）、6小时（WMD -1.10，95%可信区间：-1.45，-0.75）、12小时（WMD -0.78，95%可信区间：-1.23，-0.32）和24小时（WMD -0.54，95%可信区间：-0.83，-0.25）的疼痛评分相对较低。接受ESPB的患者术后恶心呕吐（PONV）风险较低（RR 0.32，95%可信区间：0.19，0.54）。两组在手术时间、术中失血量和住院时间方面没有差异。汇总结果的质量被判定为低到中等。
ESPB可能对脊柱手术患者有效，可减轻术后疼痛以及补救镇痛需求和总阿片类药物使用量。鉴于证据质量低到中等，需要更多试验来证实这些发现。http://www.crd.york.ac.uk/PROSPERO/，标识符：CRD42021278133。
