Department of Anesthesiology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University, China.
Department of Anesthesiology, The Affiliated Hospital of Jiaxing Universit, China.
Pain Physician. 2023 Mar;26(2):E51-E62.
Postoperative pain is a concern after thoracic and breast surgeries. Recent studies have demonstrated that ultrasound-guided serratus anterior plane block (SAPB) could provide postoperative analgesia.
The objective of this systematic review and meta-analysis was to examine the effects of SAPB on postoperative analgesia in thoracic and breast surgery.
A systematic review and meta-analysis of randomized control trials (RCTs).
We systematically queried the PubMed, Embase, Web of Science, and Cochrane Library online databases from their establishment through Mar 31, 2022. Eligible RCTs were selected for the purpose of conducting the meta-analysis. The risk of bias of the included trials was assessed by Cochrane Review Manager. The level of certainty was examined utilizing the GRADE (Grade of Recommendations Assessment, Development, and Evaluation) scale to determine whether the evidence was of high quality or not.
During the process of the meta-analysis, a total of 27 pieces of literature was included in the present research. SAPB significantly reduced the intraoperative opioid consumption (mean difference [MD] = -9.52 mg of morphine equivalent, 95% CI, -15.50 to -3.54; P < 0.01, I2 = 98%) and postoperative pain opioid consumption (MD = -23.12 mg of morphine equivalent, 95% CI, -30.59 to -15.65; P < 0.01, I2 = 100%. Also, patients in the SAPB group had lower pain scores during the first postoperative 24 hours. Furthermore, SAPB attenuated the occurrence of postsurgical nausea and vomiting, as well as chronic postsurgical pain.
Double-blinding was not performed in some trials, also some assessors were not blinded; the included sample sizes of eligible trials which reported the incidence of chronic postsurgical pain were relatively small; the comparisons between SAPB and other types of blocks were not performed in our meta-analysis.
Our findings suggest that SAPB not only relieves acute pain after thoracic and breast surgery, but also reduces the incidence of chronic postsurgical pain.
胸科和乳腺手术后的疼痛是一个关注点。最近的研究表明，超声引导的前锯肌平面阻滞（SAPB）可以提供术后镇痛。
本系统评价和荟萃分析的目的是研究 SAPB 对胸科和乳腺手术后镇痛的影响。
对随机对照试验（RCT）的系统评价和荟萃分析。
我们系统地检索了 PubMed、Embase、Web of Science 和 Cochrane Library 在线数据库，检索时间从数据库建立到 2022 年 3 月 31 日。选择符合条件的 RCT 进行荟萃分析。使用 Cochrane Review Manager 评估纳入试验的偏倚风险。使用 GRADE（推荐评估、制定与评价）量表评估证据的确定性水平，以确定证据是否为高质量。
在荟萃分析过程中，本研究共纳入 27 篇文献。SAPB 显著减少术中阿片类药物的使用量（均数差[MD] = -9.52mg 吗啡当量，95%置信区间，-15.50 至 -3.54；P < 0.01，I2 = 98%）和术后疼痛阿片类药物的使用量（MD = -23.12mg 吗啡当量，95%置信区间，-30.59 至 -15.65；P < 0.01，I2 = 100%）。此外，SAPB 组患者在术后 24 小时内疼痛评分较低。此外，SAPB 减轻了术后恶心和呕吐以及慢性术后疼痛的发生。
一些试验未进行双盲，一些评估者未设盲；报告慢性术后疼痛发生率的合格试验的纳入样本量相对较小；我们的荟萃分析中没有比较 SAPB 与其他类型阻滞的效果。
我们的研究结果表明，SAPB 不仅可以缓解胸科和乳腺手术后的急性疼痛，还可以降低慢性术后疼痛的发生率。
