超声引导下前锯肌平面阻滞用于胸腔镜手术患者的镇痛效果：一项随机对照试验的系统评价和更新的荟萃分析。

Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials.

机构信息

Department of Anesthesiology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, 044000, Shanxi Province, China.

出版信息

BMC Anesthesiol. 2023 Jul 13;23(1):235. doi: 10.1186/s12871-023-02197-8.

BACKGROUND

Serratus anterior plane block (SAPB) is a promising regional technique for analgesia in thoracic surgery. Till now, several randomized controlled trials (RCTs) have explored the effectiveness of SAPB for postoperative pain control in patients undergoing video-assisted thoracoscopic surgery (VATS), but the sample sizes were small and conclusions remained in controversy. Therefore, we conducted the present systematic review and meta-analysis.

METHODS

RCTs evaluating the analgesic performance of SAPB, comparing to control methods (no block, placebo or local infiltration anesthesia), in patients undergoing VATS were searched in PubMed, EMBASE, Web of Science and Cochrane Library from inception to December 31, 2022. Mean difference (MD) and corresponding 95% confidence interval (95%CI) were calculated for postoperative pain scores at various time points, postoperative opioid consumption and length of hospital stay. Pooled relative risk (RR) with 95%CI were calculated for the risk of postoperative nausea and vomiting (PONV) and dizziness. A random-effect model was applied.

RESULTS

A total of 12 RCTs (837 participants) were finally included. Compared to control group, SAPB had significant reductions of postoperative pain scores at 2 h (MD = -1.58, 95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38, P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h (MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover, SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There was no difference between both groups regarding length of hospital stay and risk of dizziness.

CONCLUSION

SAPB shows an excellent performance in postoperative pain management in patients undergoing VATS by reducing pains scores, postoperative opioid consumption and incidence of PONV. However, due to huge heterogeneity, more well-designed, large-scale RCTs are needed to verify these findings in the future.

背景

胸科手术中，竖脊肌平面阻滞（SAPB）是一种很有前途的区域镇痛技术。到目前为止，已有几项随机对照试验（RCT）探讨了 SAPB 对胸腔镜辅助手术（VATS）患者术后疼痛控制的有效性，但样本量较小，结论仍存在争议。因此，我们进行了这项系统评价和荟萃分析。

方法

检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library 从建库至 2022 年 12 月 31 日的关于 SAPB 用于 VATS 术后镇痛的 RCT，纳入比较 SAPB 与对照组（无阻滞、安慰剂或局部浸润麻醉）的研究。采用均数差（MD）及其 95%置信区间（95%CI）计算术后各时间点疼痛评分、术后阿片类药物用量和住院时间。计算术后恶心呕吐（PONV）和头晕的发生率的汇总相对风险（RR）及其 95%CI。采用随机效应模型。

结果

最终纳入 12 项 RCT（837 名患者）。与对照组相比，SAPB 可显著降低术后 2 h（MD=-1.58，95%CI：-1.86 至-1.31，P<0.001）、6 h（MD=-2.06，95%CI：-2.74 至-1.38，P<0.001）、12 h（MD=-1.72，95%CI：-2.30 至-1.14，P<0.001）和 24 h（MD=-1.03，95%CI：-1.55 至-0.52，P<0.001）的疼痛评分。此外，SAPB 还可减少术后阿片类药物用量（MD=-7.3 mg 静脉吗啡当量，95%CI：-10.16 至-4.44，P<0.001）和降低 PONV 发生率（RR=0.56，95%CI：0.41 至 0.77，P<0.001）。两组在住院时间和头晕发生率方面无差异。