Department of Rehabilitation Medicine, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China.
Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3383-3395. doi: 10.26355/eurrev_202304_32109.
The review aimed to examine the evidence on the efficacy of erector spinae nerve block (ESPB) for pain control after lumbar spinal surgeries.
PubMed, CENTRAL, Embase, and Web of Science were examined for published randomized controlled trials (RCTs) assessing ESPB with control for lumbar spinal surgery patients. The primary review outcome was 24-hour total opioid consumption in morphine equivalents. The secondary review outcomes were pain at rest at 4-6 hours, 8-12 hours, 24 hours and 48 hours, first rescue analgesic timing, needing rescue analgesics number, and postoperative nausea and vomiting (PONV).
16 trials were eligible. Total opioid consumption was significantly lower with ESPB as compared to controls (MD: -12.68 95% CI: -18.09, -7.28 I2=99% p<0.00001). Pain scores at 4-6 hours (MD: -1.37 95% CI: -1.98, -0.76 I2=95% p<0.0001), 8-12 hours (MD: -1.18 95% CI:-1.84, -0.52 I2=98% p=0.0004), 24 hours (MD: -0.53 95% CI:-1.03, -0.04 I2=96% p=0.04) and 48 hours (MD: -0.36 95% CI:-0.84, 0.13 I2=88% p=0.15) were significantly lower in the ESPB group. The meta-analysis found that the ESPB group required a significantly longer time for the first analgesic request (MD: 5.26 95% CI: 2.53, 7.99 I2=100% p=0.002), had lower demand for rescue analgesics (OR: 0.12 95% CI: 0.07, 0.21 I2=2% p<0.00001) and fewer incidence of PONV (OR: 0.27 95% CI: 0.15, 0.49 I2=51% p<0.0001).
ESPB can be highly efficacious for postoperative analgesia in lumbar surgery patients. The block has the capability of reducing opioid consumption in the first 24 hours and pain scores up to 48 hours along with a significant reduction in the need for rescue analgesics and PONV.
本次综述旨在研究竖脊肌神经阻滞（ESPB）在腰椎手术后疼痛控制方面的疗效证据。
检索 PubMed、CENTRAL、Embase 和 Web of Science 中评估 ESPB 与腰椎脊柱手术患者对照的已发表随机对照试验（RCT）。主要综述结果为吗啡等效物 24 小时内的总阿片类药物消耗量。次要综述结果为术后 4-6 小时、8-12 小时、24 小时和 48 小时的静息疼痛评分、首次解救性镇痛时间、需要解救性镇痛的次数以及术后恶心呕吐（PONV）。
16 项试验符合纳入标准。与对照组相比，ESPB 组的总阿片类药物消耗量明显降低（MD：-12.68，95%CI：-18.09，-7.28，I2=99%，p<0.00001）。术后 4-6 小时（MD：-1.37，95%CI：-1.98，-0.76，I2=95%，p<0.0001）、8-12 小时（MD：-1.18，95%CI：-1.84，-0.52，I2=98%，p=0.0004）、24 小时（MD：-0.53，95%CI：-1.03，-0.04，I2=96%，p=0.04）和 48 小时（MD：-0.36，95%CI：-0.84，0.13，I2=88%，p=0.15）的疼痛评分明显降低。荟萃分析发现，ESPB 组首次请求镇痛的时间明显延长（MD：5.26，95%CI：2.53，7.99，I2=100%，p=0.002），对解救性镇痛的需求降低（OR：0.12，95%CI：0.07，0.21，I2=2%，p<0.00001），PONV 的发生率降低（OR：0.27，95%CI：0.15，0.49，I2=51%，p<0.0001）。
ESPB 对腰椎手术患者的术后镇痛非常有效。该阻滞术具有减少术后 24 小时内阿片类药物消耗和疼痛评分的能力，可降低 48 小时内对解救性镇痛的需求和 PONV 的发生率。
