外周神经阻滞与全身麻醉在上肢手术中对功能恢复的影响：系统评价。
Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review.
机构信息
Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
Divisions of Cardiology and Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
出版信息
BMC Anesthesiol. 2023 Mar 24;23(1):91. doi: 10.1186/s12871-023-02038-8.
BACKGROUND
Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery.
METHODS
We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach.
RESULTS
We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N = 160; SMD -0.15; CI at 95% -0.60-0.3; I = 45%; p = 0.07; low quality of evidence and 3 observational studies, N = 377; SMD -0.35; CI at 95% -0.71-0.01; I = 64%; p = 0.06; very low quality of evidence).
CONCLUSIONS
Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745).
TRIAL REGISTRATION
PROSPERO ID CRD42018116298. Registered on December 4, 2018.
背景
周围神经阻滞是上肢骨科手术中常用的麻醉技术。在目标神经周围注射局部麻醉剂可抑制电压门控钠离子通道的作用，从而抑制疼痛冲动的神经传递，提供运动性不动。与全身麻醉相比，它可以通过抑制伤害性冲动和炎症来改善功能恢复，从而减轻术后疼痛和固定，改善术后康复。本系统评价评估了周围神经阻滞与全身麻醉对上肢骨科手术后术后功能恢复的影响。
方法
我们从 CENTRAL、MEDLINE、CINHAL、EMBASE 和 Scopus 试验数据库中搜索了从开始到 2021 年 9 月比较周围神经阻滞与全身麻醉的研究。我们收集了功能恢复、运动范围、患者满意度、生活质量和重返工作的数据。我们使用随机效应模型汇总研究数据，并使用 GRADE 方法总结证据质量。
结果
我们评估了 373 条引文和 19 篇全文文章的资格，并纳入了 6 项研究。6 项研究报告了功能恢复情况，但未能发现周围神经阻滞优于全身麻醉（3 项 RCT 研究，N=160；SMD-0.15；95%CI 在-0.60 至 0.3；I=45%；p=0.07；低质量证据和 3 项观察性研究，N=377；SMD-0.35；95%CI 在-0.71 至 0.01；I=64%；p=0.06；极低质量证据）。
结论
目前的文献有限，无法确定周围神经阻滞对功能恢复的益处。需要更多的研究来评估对长期恢复的影响。考虑到其对临床实践和培训的潜在影响，一项关于功能恢复的前瞻性研究正在进行中（NCT04541745）。
试验注册
PROSPERO ID CRD42018116298。于 2018 年 12 月 4 日注册。
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