Pisljagic Sanja, Temberg Jens L, Steensbaek Mathias T, Yousef Sina, Maagaard Mathias, Chafranska Lana, Lange Kai H W, Rothe Christian, Lundstrøm Lars H, Nørskov Anders K
Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.
Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
Acta Anaesthesiol Scand. 2024 Mar;68(3):423-429. doi: 10.1111/aas.14353. Epub 2023 Nov 6.
Current methods of anaesthesia used for closed reduction of distal radial fractures may be insufficient for pain relief and muscle relaxation, potentially compromising reduction quality and patient satisfaction. Peripheral nerve blocks have already been implemented for surgery of wrist fractures and may provide optimal conditions for closed reduction due to complete motor and sensory blockade of the involved nerves. However, existing literature on peripheral nerve blocks for closed reduction is sparse, and no updated systematic review or meta-analysis exists.
This protocol is developed according to the PRISMA-P statement. The systematic review and meta-analysis aim to consolidate the literature regarding the effect and harm of peripheral nerve blocks compared with other anaesthesia modalities for closed reduction of distal radius fractures in adults.
The two primary outcomes are the proportion of participants needing surgery after closed reduction and pain during closed reduction. We will only include randomised clinical trials. Two review authors will each independently screen literature, extract data, and assess risk of bias with Risk of Bias 2 Tool. Meta-analysis will be carried out with Rstudio. We will also perform a Trial Sequential Analysis. The certainty of evidence will be judged using GRADE guidelines.
We will use up-to-date methodology when conducting the systematic review outlined in this protocol. The results may guide clinicians in their decision-making regarding the use of anaesthesia for closed reduction of distal radius fractures in adults.
目前用于桡骨远端骨折闭合复位的麻醉方法可能在缓解疼痛和肌肉松弛方面不足，这可能会影响复位质量和患者满意度。周围神经阻滞已应用于腕部骨折手术，由于对受累神经的运动和感觉进行了完全阻滞，可能为闭合复位提供最佳条件。然而，关于周围神经阻滞用于闭合复位的现有文献较少，且尚无更新的系统评价或荟萃分析。
本方案根据PRISMA-P声明制定。该系统评价和荟萃分析旨在整合与其他麻醉方式相比，周围神经阻滞用于成人桡骨远端骨折闭合复位的效果和危害的相关文献。
两个主要结局是闭合复位后需要手术的参与者比例和闭合复位期间的疼痛。我们将仅纳入随机临床试验。两位综述作者将各自独立筛选文献、提取数据，并使用偏倚风险2工具评估偏倚风险。将使用Rstudio进行荟萃分析。我们还将进行试验序贯分析。将使用GRADE指南判断证据的确定性。
在进行本方案概述的系统评价时，我们将采用最新的方法。结果可能会指导临床医生在成人桡骨远端骨折闭合复位麻醉使用方面的决策。
