Department of Thoracic Surgery, Xinjiang Medical University, First Affiliated Hospital, Urumqi, China.
Int J Surg. 2023 Aug 1;109(8):2404-2413. doi: 10.1097/JS9.0000000000000167.
This network meta-analysis was performed to assess the relative efficacy and safety of various regional analgesic techniques used in thoracic surgery.
Randomized controlled trials evaluating different regional analgesic methods were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to March 2021. The surface under the cumulative ranking curve) was estimated to rank the therapies based on the Bayesian theorem. Moreover, sensitivity and subgroup analyses were performed on the primary outcomes to obtain more reliable conclusions.
Fifty-four trials (3360 patients) containing six different methods were included. Thoracic paravertebral block and erector spinae plane block (ESPB) were ranked the highest in reducing postoperative pain. As for total adverse reactions and postoperative nausea and vomiting, postoperative complications, and duration of hospitalization, ESPB was found to be superior to other methods. It should be noted that there were few differences between various methods for all outcomes.
Available evidence suggests that ESPB might be the most effective and safest method for relieving pain after thoracic surgery, shortening the length of hospital stay and reducing the incidence of postoperative complications.
本网状荟萃分析旨在评估用于胸外科的各种区域镇痛技术的相对疗效和安全性。
从数据库中检索了评价不同区域镇痛方法的随机对照试验，包括 PubMed、Embase、Web of Science 和 Cochrane Library，检索时间从建库至 2021 年 3 月。采用贝叶斯定理估计累积排序曲线下面积（surface under the cumulative ranking curve，SUCRA），对治疗方法进行排序。此外，对主要结局进行敏感性和亚组分析，以获得更可靠的结论。
纳入了 54 项试验（3360 例患者），包含 6 种不同方法。胸椎旁阻滞和竖脊肌平面阻滞（erector spinae plane block，ESPB）在减轻术后疼痛方面的排名最高。对于总不良反应、术后恶心和呕吐、术后并发症以及住院时间，ESPB 优于其他方法。需要注意的是，对于所有结局，各种方法之间的差异均不大。
现有证据表明，ESPB 可能是缓解胸外科术后疼痛最有效和最安全的方法，可缩短住院时间并降低术后并发症的发生率。
