Cui Yi-Yang, Xu Zi-Qing, Hou Huai-Jing, Zhang Jie, Xue Jian-Jun
First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District, Lanzhou, China.
Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China.
J Cardiothorac Vasc Anesth. 2024 May;38(5):1228-1238. doi: 10.1053/j.jvca.2024.02.016. Epub 2024 Feb 23.
Pediatric patients undergoing cardiac surgery usually experience significant surgical pain. Additionally, the effect of poor surgical analgesia creates a pain continuum that extends to the postoperative period. Transversus thoracic muscle plane block (TTMPB) is a novel plane block technique that can provide analgesia to the anterior chest wall. The analgesic role of TTMPB in pediatric cardiac surgery is still uncertain. A meta-analysis was conducted to determine the analgesic efficacy of this procedure.
Systematic review and meta-analysis. PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure were searched to November 2023, and the Grading of Recommendations Assessment, Development, and Evaluation approach was followed to evaluate the certainty of evidence.
Eligible studies enrolled pediatric patients from 2 months to 12 years old scheduled to undergo cardiac surgery, and randomized them to receive a TTMPB or no block/sham block.
Six studies that enrolled 601 pediatric patients were included. Low-certainty evidence from randomized trials showed that, compared with no block or sham block, TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative modified objective pain score at 12 hours (weighted mean difference [WMD] -2.20, 95% CI -2.73 to -1.68) and 24 hours (WMD -1.76, 95% CI -2.09 to -1.42), intraoperative opioid consumption (WMD -3.83, 95% CI -5.90 to -1.76 μg/kg), postoperative opioid consumption (WMD -2.51, 95% CI -2.84 to -2.18 μg/kg), length of intensive care unit (ICU) stay (WMD -5.56, 95% CI -8.30 to -2.83 hours), and extubation time (WMD -2.13, 95% CI -4.21 to -0.05 hours). Retrospective studies provided very low certainty that the results were consistent with the randomized trials.
Very low- to low-certainty evidence showed that TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative pain, opioid consumption, ICU length of stay, and extubation time.
接受心脏手术的儿科患者通常会经历严重的手术疼痛。此外，手术镇痛效果不佳会形成一个疼痛连续体，延伸至术后阶段。胸横肌平面阻滞（TTMPB）是一种新型的平面阻滞技术，可为前胸壁提供镇痛。TTMPB在小儿心脏手术中的镇痛作用仍不确定。进行了一项荟萃分析以确定该手术的镇痛效果。
系统评价和荟萃分析。检索了截至2023年11月的PubMed、Embase、Web of Science、CENTRAL、万方数据和中国知网，并采用推荐意见评估、制定和评价方法来评估证据的确定性。
符合条件的研究纳入了计划接受心脏手术的2个月至12岁的儿科患者，并将他们随机分为接受TTMPB组或不进行阻滞/假阻滞组。
纳入了6项涉及601名儿科患者的研究。随机试验的低确定性证据表明，与不进行阻滞或假阻滞相比，接受心脏手术的儿科患者使用TTMPB可能会降低术后12小时（加权平均差[WMD] -2.20，95%置信区间[-2.73，-1.68]）和24小时（WMD -1.76，95%置信区间[-2.09，-1.42]）的改良客观疼痛评分、术中阿片类药物消耗量（WMD -3.83，95%置信区间[-5.90，-1.76]μg/kg）、术后阿片类药物消耗量（WMD -2.51，95%置信区间[-2.84，-2.18]μg/kg）、重症监护病房（ICU）住院时间（WMD -5.56，95%置信区间[-8.30，-2.83]小时）和拔管时间（WMD -2.13，95%置信区间[-4.21，-0.05]小时）。回顾性研究提供的确定性极低，表明结果与随机试验一致。
极低至低确定性证据表明，接受心脏手术的儿科患者使用TTMPB可能会减轻术后疼痛、减少阿片类药物消耗量、缩短ICU住院时间和拔管时间。
