成人心脏手术后区域麻醉技术用于术后镇痛的比较：贝叶斯网络Meta分析
Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis.
作者信息
Zhou Ke, Li Dongyu, Song Guang
机构信息
Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
出版信息
Front Cardiovasc Med. 2023 May 22;10:1078756. doi: 10.3389/fcvm.2023.1078756. eCollection 2023.
BACKGROUND
Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear.
METHODS
Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality.
RESULTS
This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques.
CONCLUSIONS
TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.
背景
心脏手术后患者通常会遭受急性疼痛。众多区域麻醉技术已被用于接受全身麻醉的此类患者。最有效的区域麻醉技术仍不明确。
方法
检索了五个数据库，包括PubMed、MEDLINE、Embase、ClinicalTrials.gov和Cochrane图书馆。在这项贝叶斯分析中，有效性结果包括疼痛评分、吗啡累积用量以及急救镇痛的需求。术后恶心、呕吐和瘙痒为安全性结果。功能结果包括气管拔管时间、重症监护病房（ICU）住院时间、住院时间和死亡率。
结果
这项荟萃分析纳入了65项随机对照试验，涉及5013例患者。涉及八种区域麻醉技术，包括胸段硬膜外镇痛（TEA）、竖脊肌平面阻滞和胸横肌平面阻滞。与对照组（未接受区域麻醉技术者）相比，TEA降低了静息和咳嗽时6、12、24和48小时的疼痛评分，降低了急救镇痛的需求率（OR = 0.10，95%CI：0.016 - 0.55），缩短了气管拔管时间（MD = -181.55，95%CI：-243.05至-121.33）以及住院时间（MD = -0.73，95%CI：-1.22至-0.24）。竖脊肌平面阻滞降低了静息时6小时的疼痛评分和瘙痒风险，与对照组相比缩短了ICU住院时间。胸横肌平面阻滞与对照组相比降低了静息时6和12小时的疼痛评分。各技术在24、48小时的吗啡累积用量相似。这些区域麻醉技术的其他结果也相似。
结论
通过降低疼痛评分和减少急救镇痛需求率，TEA似乎是心脏手术后患者最有效的区域术后麻醉方法。
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