Liu Guoqing, Gao Meiling, Hu Yang, Wang Bangjun, Lin Yunhua, Guan Yuting, Chen Gang, Zhang Peng, Hu Yinghua, Cai Qiang, Qin Wen
The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
J Cardiothorac Vasc Anesth. 2023 May;37(5):788-800. doi: 10.1053/j.jvca.2022.11.001. Epub 2022 Nov 5.
The effects of the transversus thoracic muscle plane (TTP) block on postoperative pain have become increasingly controversial. This meta-analysis compared the effects of the TTP block versus no block on postoperative analgesia and side effects to determine whether this new technique is a reliable alternative for pain management. PubMed, Cochrane Library, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure, Chongqing VIP information, and Wanfang Data were searched for clinical studies investigating the analgesic effect of the TTP block compared to controls. The primary outcomes included the postoperative pain scores at rest and during movement, morphine consumption in 24 hours, and the rate of postoperative nausea and vomiting (PONV). Eleven randomized controlled trials (RCTs), including 682 patients, were reviewed. The meta-analysis showed that the TTP block significantly could reduce the pain scores at 0 (at rest: mean difference [MD], -2.28; 95% CI: -2.67 to -1.90) (during movement: MD: -2.09, 95% CI: -2.62 to -1.56) and 12 hours (at rest: -1.42, 95% CI: -2.03 to -0.82) (during movement: MD: -2.13, 95% CI: -2.80 to -1.46) after surgery, 24-hour postoperative analgesic consumption (MD: -23.18, 95% CI: -33.71 to -12.66), and the incidence of PONV (odds ratio, 0.36, 95% CI: 0.15-0.88). Furthermore, the trial sequence analysis confirmed the result of less 24-hour postoperative analgesic consumption in the TTP block group. As a novel technique, the TTP block exhibited a superior postoperative analgesic effect during the early postoperative period. Nevertheless, additional well-designed RCTs are needed.
胸横肌平面（TTP）阻滞对术后疼痛的影响一直存在争议。本荟萃分析比较了TTP阻滞与不阻滞对术后镇痛及副作用的影响，以确定这项新技术是否是疼痛管理的可靠替代方法。检索了PubMed、Cochrane图书馆、Embase、科学网、ClinicalTrials.gov、中国知网、重庆维普资讯和万方数据，查找关于TTP阻滞与对照组相比镇痛效果的临床研究。主要结局包括静息和活动时的术后疼痛评分、24小时吗啡用量以及术后恶心呕吐（PONV）发生率。共纳入11项随机对照试验（RCT），涉及682例患者。荟萃分析表明，TTP阻滞可显著降低术后0小时（静息时：平均差[MD]，-2.28；95%置信区间：-2.67至-1.90）（活动时：MD：-2.09，95%置信区间：-2.62至-1.56）和12小时（静息时：-1.42，95%置信区间：-2.03至-0.82）（活动时：MD：-2.13，95%置信区间：-2.80至-1.46）的疼痛评分、术后24小时镇痛药物用量（MD：-23.18，95%置信区间：-33.71至-12.66）以及PONV发生率（比值比，0.36，95%置信区间：0.15 - 0.88）。此外，试验序贯分析证实了TTP阻滞组术后24小时镇痛药物用量较少的结果。作为一种新技术，TTP阻滞在术后早期表现出较好的镇痛效果。然而，仍需要更多设计良好的RCT。
