超声引导竖脊肌平面阻滞用于经皮肾镜取石术后镇痛的安全性和有效性：系统评价和荟萃分析。
The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis.
机构信息
School of Nursing, Weifang Medical University, Weifang, China.
Weifang People's Hospital, Weifang Medical University, Weifang, China.
出版信息
PLoS One. 2023 Jul 14;18(7):e0288781. doi: 10.1371/journal.pone.0288781. eCollection 2023.
BACKGROUND
The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL.
METHODS
The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols.
RESULTS
There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404).
CONCLUSIONS
Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.
背景
接受经皮肾镜碎石术（PCNL）的患者术后疼痛和不适严重。竖脊肌平面阻滞（ESPB）作为一种新的平面阻滞麻醉方法，对术后镇痛有积极作用。但 ESPB 在 PCNL 中的证据仍然缺乏。本研究的目的是系统分析 ESPB 对接受 PCNL 治疗的患者的术后镇痛效果。
方法
在 PubMed、EMBASE、Cochrane 图书馆和临床试验数据库（clinicaltrials.gov）中进行文献检索。两名独立的研究人员筛选纳入的研究并提取数据。采用随机效应模型和 95%置信区间进行荟萃分析。采用 Chi-squared 检验，显著性水平为 0.1，用于评估纳入研究的异质性。在存在高异质性的研究中进行亚组分析和荟萃回归分析。根据前瞻性试验注册与报告方案之间是否存在差异，评估发表偏倚。
结果
有 8 项研究纳入了 456 例患者，评估了 ESPB 与无阻滞或其他阻滞（如皮下浸润、全身麻醉或 TPVB 鞘内吗啡）相比，减轻 PCNL 术后疼痛评分的效果。ESPB 是一种有效且安全的麻醉方法，不仅改善了术后疼痛反应（MD -1.76；95%CI -2.57 至 -0.94；I 2 = 85%；p<0.01），还减少了镇痛药物的消耗（MD -16.92；95%CI -26.25 至 -7.59；I 2 = 92.2%；p<0.01）和延长了术后首次请求镇痛的时间（MD 93.27；95%CI 35.79 至 150.75；I 2 = 85.3%；p = 0.001），而无明显术后并发症（MD 0.80；95%CI 0.31 至 2.03；I 2 = 0%；p = 0.404）。
结论
与无阻滞或其他阻滞相比，ESPB 是接受 PCNL 治疗的患者安全有效的麻醉方法。
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