Su Peng, Liu Yijia, Zhang Lu, Bai Long-Bin
Department of Hand and Foot Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China.
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Orthop J Sports Med. 2023 May 24;11(5):23259671231167128. doi: 10.1177/23259671231167128. eCollection 2023 May.
The optimal method for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) is still unclear.
To compare the efficacy of postoperative analgesic methods after ARCR through network meta-analysis of randomized controlled trials and prospective controlled trials.
Systematic review; Level of evidence, 2.
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Embase, and Web of Science from inception until April 12, 2022, for randomized controlled trials and prospective controlled trials evaluating neuraxial analgesia, peripheral nerve block, periarticular local anesthetic infiltration, intravenous patient-controlled analgesia, oral analgesia, or any combination of these methods for pain management after ARCR. Outcomes included pain scores at rest, morphine consumption, and complications (nausea and vomiting). Study quality was assessed using the Cochrane risk-of-bias tool. Network meta-analysis was used to assess the relative efficacy of the methods for postoperative analgesia. The best choice for postoperative analgesia was defined as the one with significant differences in pain scores and morphine consumption compared with placebo, with no significant difference in complications, during the initial 48 hours postoperatively.
Included were 42 studies with 3110 patients. Only suprascapular nerve block (SSNB) was significantly superior to placebo in pain scores (mean difference [MD], -0.93 [95% CI, -1.31 to -0.54] at 6 hours; MD, -2.34 [95% CI, -3.49 to -1.19] at 12 hours) and morphine consumption (MD, -17.70 [95% CI, -32.98 to -2.42] at 24 hours) ( < .05 for all), with no difference in complications (odds ratio, 0.96 [95% CI, 0.21 to 4.32]; > .05). Pain scores were significantly lower with interscalene nerve block compared with SSNB (MD, -0.69 [95% CI, -1.17 to -0.20] at 6 hours; MD, -1.44 [95% CI, -2.21 to -0.67] at 12 hours) and with SSNB + axillary nerve block compared with SSNB (MD, -3.09 [95% CI, -4.18 to -1.99] at 6 hours; MD, -0.87 [95% CI, -1.71 to -0.03] at 12 hours) ( < .05 for all).
Based on the current evidence, most analgesic methods lowered pain and morphine consumption compared with placebo. There were significant differences in pain scores between interscalene nerve block and SSNB during the first 12 hours postoperatively, and adding axillary nerve block to SSNB enhanced the analgesic effect.
关节镜下肩袖修补术（ARCR）后术后镇痛的最佳方法仍不明确。
通过对随机对照试验和前瞻性对照试验进行网状Meta分析，比较ARCR术后镇痛方法的疗效。
系统评价；证据等级，2级。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，我们检索了PubMed、Embase和Web of Science数据库，从建库至2022年4月12日，查找评估神经轴索镇痛、外周神经阻滞、关节周围局部麻醉药浸润、静脉自控镇痛、口服镇痛或这些方法的任何组合用于ARCR后疼痛管理的随机对照试验和前瞻性对照试验。结局指标包括静息时疼痛评分、吗啡用量和并发症（恶心和呕吐）。使用Cochrane偏倚风险工具评估研究质量。采用网状Meta分析评估术后镇痛方法的相对疗效。术后镇痛的最佳选择定义为术后最初48小时内与安慰剂相比疼痛评分和吗啡用量有显著差异，并发症无显著差异的方法。
纳入42项研究，共3110例患者。仅肩胛上神经阻滞（SSNB）在疼痛评分（6小时时平均差值[MD]，-0.93[95%可信区间，-1.31至-0.54]；12小时时MD，-2.34[95%可信区间，-3.49至-1.19]）和吗啡用量（24小时时MD，-17.70[95%可信区间，-32.98至-2.42]）方面显著优于安慰剂（所有P<0.05），并发症方面无差异（比值比，0.96[95%可信区间，0.21至4.32]；P>0.05）。与SSNB相比，肌间沟神经阻滞时疼痛评分显著更低（6小时时MD，-0.69[95%可信区间，-1.17至-0.20]；12小时时MD，-1.44[95%可信区间，-2.21至-0.67]），与SSNB相比，SSNB+腋神经阻滞时疼痛评分也显著更低（6小时时MD，-3.09[95%可信区间，-4.18至-1.99]；12小时时MD，-0.87[95%可信区间，-1.71至-0.03]）（所有P<0.05）。
基于目前的证据，与安慰剂相比，大多数镇痛方法可降低疼痛和吗啡用量。术后最初12小时内，肌间沟神经阻滞和SSNB的疼痛评分存在显著差异，在SSNB基础上加用腋神经阻滞可增强镇痛效果。
