Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy -
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Minerva Anestesiol. 2023 Nov;89(11):1042-1050. doi: 10.23736/S0375-9393.23.17510-9. Epub 2023 Sep 5.
The 2018 guidelines for enhanced recovery in thoracic surgery recommend paravertebral block (PVB) for postoperative pain management. However, recent studies demonstrate that erector spinae plane block (ESPB) achieves similar postoperative pain control with reduced block-related complications.
We conducted a meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and safety of ESPB versus PVB for pain management after thoracic surgery. PubMed, Embase, and Scopus were searched through December 2022 (PROSPERO registration - CRD42023395593). Primary outcomes were postoperative pain scores, resting at 6, 12, 24, and 48 hours, and at movement at 24 and 48 hours. Secondary outcomes included opioid consumption at 24 and 48 hours, and incidence of postoperative nausea and vomiting or block-related complications in the first 48 hours.
Ten randomized control trials enrolling a total of 624 total patients were included. There were no significant differences in pain scores, resting or at movement, at any time points except reduced resting pain scores at 12 hours with PVB (mean difference [MD]) 0.60, 95% confidence interval [CI] 0.32 to 0.88). Opioid consumption demonstrated no significant differences at 24 hours; PVB reduced opioid consumption at 48 hours (MD 0.40, 95% CI -0.09 to 0.89). There were no significant differences in postoperative nausea or vomiting. ESPB exhibited a nonsignificant trend toward reduced cumulative block-related complications (risk difference [RD] 0.05, 95% CI -0.10 to 0.00).
Compared with PVB, ESPB is safe and demonstrates no clinically significant differences in pain management after thoracic surgery.
2018 年胸外科加速康复指南建议使用椎旁阻滞（PVB）进行术后疼痛管理。然而，最近的研究表明，竖脊肌平面阻滞（ESPB）在减少与阻滞相关的并发症的同时，也能达到相似的术后疼痛控制效果。
我们对随机对照试验进行了荟萃分析，以评估 ESPB 与 PVB 用于胸外科手术后疼痛管理的镇痛效果和安全性。检索了 PubMed、Embase 和 Scopus 数据库，检索时间截至 2022 年 12 月（PROSPERO 注册-CRD42023395593）。主要结局指标为术后 6、12、24 和 48 小时的静息疼痛评分，以及 24 和 48 小时的运动时疼痛评分。次要结局指标包括 24 和 48 小时的阿片类药物消耗量，以及术后 48 小时内恶心和呕吐或与阻滞相关的并发症发生率。
共纳入了 10 项随机对照试验，总计 624 例患者。除了 PVB 在 12 小时时静息疼痛评分降低（MD 0.60，95%CI 0.32 至 0.88）外，两组在任何时间点的疼痛评分、静息或运动时均无显著差异。在 24 小时时，阿片类药物消耗量无显著差异；PVB 在 48 小时时减少了阿片类药物的消耗量（MD 0.40，95%CI -0.09 至 0.89）。两组术后恶心和呕吐发生率无显著差异。ESPB 显示出减少与阻滞相关的并发症的非显著趋势（RD 0.05，95%CI -0.10 至 0.00）。
与 PVB 相比，ESPB 是安全的，在胸外科手术后的疼痛管理中没有显示出具有临床意义的差异。
