髋关节手术患者关节周围神经群阻滞用于术后镇痛的疗效：一项随机对照试验的系统评价和荟萃分析

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials.

作者信息

Yu Liang, Shen Xiaojuan, Liu He

机构信息

Department of Anesthesiology, Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China.

Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China.

出版信息

Front Med (Lausanne). 2023 Feb 24;10:1084532. doi: 10.3389/fmed.2023.1084532. eCollection 2023.

BACKGROUND

As an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery.

METHODS

A total of 497 academic articles were identified after a systematic search in the databases of PubMed, Embase, Web of Science, and Cochrane Library up to 25 August 2022. The primary outcome was postoperative 24-h morphine consumption. Secondary outcomes included the time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and incidence of postoperative nausea and vomiting (PONV). We calculated mean differences (MDs) with 95% confidence intervals (CIs) for postoperative 24-h morphine consumption, time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and odds ratios (ORs) with 95% CIs for incidence of PONV. The chi-square test was used for heterogeneity analysis, and heterogeneity was assessed by . Statistical analysis was performed using Review Manager 5.4.

RESULTS

Numerous electronic databases were searched, and finally, nine studies were identified. There was no significant difference in morphine consumption during the postoperative 24 h [MD: -2.57, 95% CI: (-5.42, 0.27), = 0.08] and the time of the first request for rescue analgesia [MD: 1.79, 95% CI: (-1.06, 4.64), = 0.22] between the PENG block and control groups. PENG block did not reveal a significant difference in 6 h [MD: -0.17, 95% CI: (-0.92, 0.57), = 0.65] [MD: -0.69, 95% CI: (-1.58, 0.21), = 0.13] and 24 h [MD: -0.25, 95% CI: (-1.54, 1.05), = 0.71], [MD: 0.05, 95% CI: (-0.84, 0.93), = 0.91] static and dynamic pain scores compared with other nerve block methods. Moreover, the two groups have a similar risk of PONV (OR: 1.29, 95% CI = 0.53-3.10, = 0.57).

CONCLUSION

This review shows that PENG block can act as an alternative multimodal analgesia for hip surgery, and compared with the other kinds of nerve block, there was no significant difference in the postoperative analgesic effect of PENG block.

SYSTEMATIC REVIEW REGISTRATION

Supplementary Datasheet 1, identifier: CRD 42022356496.

背景

作为一种可选的区域麻醉方法，关节囊周围神经群（PENG）阻滞已成功用于髋部手术的疼痛管理，且不影响运动功能。本荟萃分析旨在验证PENG阻滞对接受髋部手术患者术后镇痛的疗效。

方法

截至2022年8月25日，在PubMed、Embase、科学网和考克兰图书馆数据库中进行系统检索后，共识别出497篇学术文章。主要结局为术后24小时吗啡消耗量。次要结局包括首次要求使用补救镇痛药的时间、术后6小时和24小时的静态和动态疼痛评分，以及术后恶心呕吐（PONV）的发生率。我们计算了术后24小时吗啡消耗量、首次要求使用补救镇痛药的时间、术后6小时和24小时的静态和动态疼痛评分的平均差（MDs）及95%置信区间（CIs），以及PONV发生率的比值比（ORs）及95% CIs。采用卡方检验进行异质性分析，并通过评估异质性。使用Review Manager 5.4进行统计分析。

结果

检索了众多电子数据库，最终确定了9项研究。PENG阻滞组与对照组在术后24小时吗啡消耗量[MD：-2.57，95% CI：（-5.42，0.27）， = 0.08]和首次要求使用补救镇痛药的时间[MD：1.79，95% CI：（-1.06，4.64）， = 0.22]方面无显著差异。与其他神经阻滞方法相比，PENG阻滞在术后6小时[MD：-0.17，95% CI：（-0.92，0.57）， = 0.65][MD：-0.69，95% CI：（-1.58，0.21）， = 0.13]和24小时[MD：-0.25，95% CI：（-1.54，1.05）， = 0.71]，[MD：0.05，95% CI：（-0.84，0.93）， = 0.91]的静态和动态疼痛评分方面无显著差异。此外，两组PONV的风险相似（OR：1.29，95% CI = 0.53 - 3.10， = 0.57）。