Jiangping Wu, Xiaolin Quan, Han Shu, Zhou Xiaolan, Mao Nie, Zhibo Deng, Ting Gong, Shidong Hu, Xiangwei Li, Xin Yuan, Guoyin Shu
Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China.
Front Med (Lausanne). 2022 Jul 8;9:921016. doi: 10.3389/fmed.2022.921016. eCollection 2022.
Shoulder arthroscopic surgery is a common surgical method used in orthopedics. However, severe postoperative pain can significantly limit the early joint movement of patients and adversely affect the impact of the surgery. At present, there is no consistent and effective analgesic scheme for the management of postoperative pain after arthroscopic surgery of the shoulder.
The aim of this study was to search for the most effective analgesic scheme to control pain in the perioperative period of arthroscopic surgery of the shoulder.
Network meta-analysis.
We searched 5 different databases (i.e., Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from January 2011 to January 2021 for English literature. Thereafter, we sifted out randomized controlled trials (RCTs), which compared different intervention schemes for pain management after shoulder arthroscopy and selected only 12 h, 24 h, or 48 h after the patient leaves the operating room as an optimal period for administration of analgesic intervention schemes. Only patients with shoulder disease who have undergone arthroscopic shoulder surgery were included in this study. The Cochrane "risk of bias" was used for the quality assessment. Moreover, some additional tests were performed to enhance the credibility of the results.
Twenty-nine RCTs involving 1,885 patients were included in this frequentist network meta-analysis (NMA). These articles mainly were divided into two distinct groups, namely, the nerve block group and the non-nerve block group. Regarding the nerve block group, at postoperative 12 h, the intervention suprascapular nerve block + interscalene nerve block (SSNB + INB) was ranked first, whereas INB + intra-articular injection (INB + IAI) was ranked first at 24 h and 48 h postoperation. In the non-nerve block group, external application (EA) was ranked first at postoperative 12 h, but oral administration (OA) exhibited a better analgesic effect at postoperative 24 h and postoperative 48 h.
We conclude that the analgesic effect of SSNB+INB was the best at postoperative 12 h, and INB+IAI was the best at postoperative 24 h and 48 h in the nerve block group. For the non-nerve block group, the effect of EA was the best at postoperative 12 h, and the analgesic effect of OA at postoperative 24 h and 48 h was significantly better than any other interventions.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021286777.
肩关节镜手术是骨科常用的手术方法。然而，术后剧痛会显著限制患者早期关节活动，并对手术效果产生不利影响。目前，对于肩关节镜手术后疼痛的管理，尚无一致有效的镇痛方案。
本研究旨在寻找最有效的镇痛方案，以控制肩关节镜手术围手术期的疼痛。
网状Meta分析。
我们检索了2011年1月至2021年1月期间5个不同的数据库（即Medline、PubMed、Embase、Web of Science和Cochrane图书馆）以查找英文文献。之后，我们筛选出比较肩关节镜检查后不同疼痛管理干预方案的随机对照试验（RCT），并仅选择患者离开手术室后12小时、24小时或48小时作为镇痛干预方案给药的最佳时间段。本研究仅纳入接受肩关节镜手术的肩部疾病患者。采用Cochrane “偏倚风险” 进行质量评估。此外，还进行了一些额外的检验以提高结果的可信度。
本频率学派网状Meta分析（NMA）纳入了29项涉及1885例患者的RCT。这些文章主要分为两个不同的组，即神经阻滞组和非神经阻滞组。在神经阻滞组中，术后12小时，干预措施肩胛上神经阻滞 + 肌间沟神经阻滞（SSNB + INB）排名第一，而术后24小时和48小时，INB + 关节内注射（INB + IAI）排名第一。在非神经阻滞组中，术后12小时外用（EA）排名第一，但术后24小时和48小时口服给药（OA）显示出更好的镇痛效果。
我们得出结论，在神经阻滞组中，术后12小时SSNB + INB的镇痛效果最佳，术后24小时和48小时INB + IAI最佳。对于非神经阻滞组，术后12小时EA效果最佳，术后24小时和48小时OA镇痛效果明显优于任何其他干预措施。
