Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
BMC Anesthesiol. 2022 Jun 21;22(1):192. doi: 10.1186/s12871-022-01720-7.
Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to conventional analgesia for preoperative pain management in hip fractures. Five databases were searched until June 2021 to identify randomised controlled trials. Two independent authors extracted data and assessed risk of bias. Data was pooled for meta-analysis and quality of evidence was evaluated using Grades of Recommendation Assessment, Development and Evaluation (GRADE). We included 12 trials (976 participants) comparing ultrasound-guided nerve blocks to conventional systemic analgesia. In favour of ultrasound, pain measured closest to two hours after block placement decreased with a mean difference of -2.26 (VAS 0 to 10); (p < 0.001) 95% CI [-2.97 to -1.55]. In favour of ultrasound, preoperative analgesic usage of iv. morphine equivalents in milligram decreased with a mean difference of -5.34 (p=0.003) 95% CI [-8.11 to -2.58]. Time from admission until surgery ranged from six hours to more than three days. Further, ultrasound-guided nerve blocks may be associated with a lower frequency of delirium: risk ratio 0.6 (p = 0.03) 95% CI [0.38 to 0.94], fewer serious adverse events: risk ratio 0.33 (p = 0.006) 95% CI [0.15 to 0.73] and higher patient satisfaction: mean difference 25.9 (VAS 0 to 100) (p < 0.001) 95% CI [19.74 to 32.07]. However, the quality of evidence was judged low or very low. In conclusion, despite low quality of evidence, ultrasound-guided blocks were associated with benefits compared to conventional systemic analgesia.
系统评价将基于解剖标志或神经刺激的外周神经阻滞与髋部骨折患者的疼痛减轻和对全身镇痛的需求减少相关联。我们旨在研究超声引导下的神经阻滞与传统镇痛相比，在髋部骨折患者的术前疼痛管理中的效果。我们搜索了五个数据库，直到 2021 年 6 月，以确定随机对照试验。两名独立的作者提取数据并评估偏倚风险。对数据进行荟萃分析，并使用推荐评估、制定与评价（GRADE）的等级评估证据质量。我们纳入了 12 项比较超声引导下神经阻滞与传统全身镇痛的试验（976 名参与者）。支持超声的结果是，在阻滞放置后最接近两小时时测量的疼痛程度有所降低，平均差值为-2.26（VAS 0 到 10）；（p<0.001）95%CI[-2.97 到-1.55]。支持超声的结果是，静脉注射吗啡等效物的术前镇痛用量以毫克计减少了 5.34 毫克，平均差值为-5.34（p=0.003）95%CI[-8.11 到-2.58]。从入院到手术的时间从 6 小时到 3 天以上不等。此外，超声引导下的神经阻滞可能与谵妄发生率较低有关：风险比为 0.6（p=0.03）95%CI[0.38 到 0.94]，严重不良事件的发生率较低：风险比为 0.33（p=0.006）95%CI[0.15 到 0.73]，患者满意度较高：平均差值为 25.9（VAS 0 到 100）（p<0.001）95%CI[19.74 到 32.07]。然而，证据质量被判断为低或极低。总之，尽管证据质量较低，但与传统全身镇痛相比，超声引导下的阻滞与益处相关。
