Lee Myeongjong, Lee Cheol, Lim Junsung, Kim Hyungtae, Choi Yoo-Shin, Kang Hyun
Department of Anesthesiology and Pain Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, 82 Gugwondae-ro, Chungju 27376, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Republic of Korea.
J Pers Med. 2023 Jul 4;13(7):1096. doi: 10.3390/jpm13071096.
This systematic review and meta-analysis with trial sequential analysis (TSA) aimed to compare perioperative outcomes of peripheral nerve blocks (PNBs) and spinal anesthesia (SA) in elective foot and ankle surgery. The study protocol was registered in PROSPERO (CRD42021229597). Researchers independently searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs). Analysis of nine RCTs ( = 802; 399 PNBs, 403 SA) revealed significantly shorter block performance times (WMD: 7.470; 95% CI 6.072 to 8.868), the onset of sensory (WMD: 7.483; 95% CI 2.837 to 12.130) and motor blocks (WMD: 9.071; 95% CI 4.049 to 14.094), durations of sensory (WMD: 458.53; 95% CI 328.296 to 588.765) and motor blocks (WMD: 247.416; 95% CI 95.625 to 399.208), and significantly higher postoperative analgesic requirements (SMD: -1.091; 95% CI -1.634 to -0.549) in the SA group. Additionally, systolic blood pressure (SBP) at 30 min (WMD: 13.950; 95% CI 4.603 to 23.298) was lower in the SA group. The SA demonstrated shorter block performance time, faster onset and shorter duration of sensory and motor blocks, higher postoperative analgesic requirements, and lower SBP at 30 min compared to PNBs in elective foot and ankle surgery.
本项采用序贯试验分析（TSA）的系统评价和荟萃分析旨在比较择期足踝手术中周围神经阻滞（PNB）和脊髓麻醉（SA）的围手术期结局。该研究方案已在国际前瞻性注册系统（PROSPERO，注册号：CRD42021229597）登记。研究人员独立检索了PubMed、EMBASE和Cochrane对照试验中心注册库，以查找相关随机对照试验（RCT）。对9项RCT（n = 802；399例接受PNB，403例接受SA）的分析显示，SA组的阻滞操作时间显著更短（加权均数差[WMD]：7.470；95%置信区间[CI] 6.072至8.868）、感觉阻滞起效时间（WMD：7.483；95% CI 2.837至12.130）和运动阻滞起效时间（WMD：9.071；95% CI 4.049至14.094）、感觉阻滞持续时间（WMD：458.53；95% CI 328.296至588.765）和运动阻滞持续时间（WMD：247.416；95% CI 95.625至399.208）显著更短，术后镇痛需求显著更高（标准化均数差[SMD]：-1.091；95% CI -1.634至-0.549）。此外，SA组在30分钟时的收缩压（SBP）更低（WMD：13.950；95% CI 4.603至23.298）。在择期足踝手术中，与PNB相比，SA表现出更短的阻滞操作时间、更快的感觉和运动阻滞起效时间和更短的持续时间、更高的术后镇痛需求以及30分钟时更低的SBP。
