From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada.
From the Department of Anesthesia and Pain Medicine (C.P., B.J., U.S., M.W.C.), The Hospital for Sick Children, Toronto, Ontario, Canada; Systematic Overviews Through Advancing Research Technology, Child Health Evaluative Sciences (B.J.), The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada.
Am J Ophthalmol. 2024 Dec;268:108-122. doi: 10.1016/j.ajo.2024.07.015. Epub 2024 Jul 22.
To investigate the efficacy of the subtenon block in preventing postoperative complications in children undergoing strabismus surgery.
Systematic review and meta-analysis.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, and clinicaltrials.gov. All randomized controlled trials investigating the efficacy of the subtenon block in children undergoing strabismus surgery were included. Outcomes included severity of pain after surgery, number of children requiring postoperative opioid and nonopioid analgesia, and the incidences of postoperative nausea and vomiting, oculocardiac events, and block-related complications. We pooled continuous outcomes using a random-effects model to calculate the mean difference (MD) and/or standardized MD and corresponding 95% confidence intervals (CI). Dichotomous outcomes were pooled using a random-effect model to calculate the relative risk (RR) and corresponding 95% CI. Risk of bias was assessed using the Cochrane Risk of Bias instrument and quality of evidence was assessed using a Grading of Recommendations Assessment, Development, and Evaluation approach.
Nine randomized controlled trials (607 participants) were included. We found evidence for an effect of the subtenon block in reducing pain at 20 to 40 minutes after surgery (MD -1.9, 95% CI -2.2 to -1.5; high-quality evidence) and on admission to PACU (MD -1.8, 95% CI -2.2 to -1.4; moderate-quality evidence); however, there was no difference in pain scores at 6 hours after surgery. In addition, evidence was found that the subtenon block decreased the number of children requiring postoperative opioid (RR 0.59, 95% CI 0.37-0.92; high-quality evidence) and nonopioid (RR 0.52, 95% CI 0.27-0.98; moderate-quality evidence) analgesia, and the incidences of postoperative vomiting (RR 0.31, 95% CI 0.12-0.7; high-quality evidence) and intraoperative oculocardiac events (RR 0.40, 95% CI 0.26-0.60; high-quality evidence). Other secondary outcomes had low or moderate-quality evidence. Risk of bias was low in six trials and high in three. There were no reports of block-related complications.
Our findings suggest that the subtenon block reduces the severity of early postoperative pain and the incidences of postoperative vomiting and intraoperative oculocardiac events compared with controls in children undergoing strabismus surgery.
PROSPERO (CRD42015025443).
研究眼外肌后阻滞在预防儿童斜视手术后并发症中的效果。
系统评价和荟萃分析。
我们检索了 Cochrane 对照试验中心注册库、MEDLINE、EMBASE、Scopus、Web of Science 和 clinicaltrials.gov。纳入了所有研究眼外肌后阻滞在儿童斜视手术中效果的随机对照试验。结局包括手术后疼痛的严重程度、需要术后阿片类和非阿片类镇痛的儿童人数，以及术后恶心和呕吐、心动眼反射和阻滞相关并发症的发生率。我们使用随机效应模型汇总连续结局，计算均数差（MD）和/或标准化 MD 及其相应的 95%置信区间（CI）。二分类结局使用随机效应模型计算相对风险（RR）及其相应的 95%CI。使用 Cochrane 偏倚风险工具评估偏倚风险，使用 Grading of Recommendations Assessment, Development, and Evaluation 方法评估证据质量。
纳入了 9 项随机对照试验（607 名参与者）。我们发现眼外肌后阻滞在减少术后 20-40 分钟（MD-1.9，95%CI-2.2 至-1.5；高质量证据）和 PACU 入院时（MD-1.8，95%CI-2.2 至-1.4；中等质量证据）疼痛方面有效果；然而，术后 6 小时的疼痛评分无差异。此外，证据表明眼外肌后阻滞减少了术后需要阿片类（RR 0.59，95%CI 0.37-0.92；高质量证据）和非阿片类（RR 0.52，95%CI 0.27-0.98；中等质量证据）镇痛的儿童人数，以及术后呕吐（RR 0.31，95%CI 0.12-0.7；高质量证据）和术中心动眼反射（RR 0.40，95%CI 0.26-0.60；高质量证据）的发生率。其他次要结局的证据质量为低或中等。6 项试验的偏倚风险低，3 项试验的偏倚风险高。没有报告与阻滞相关的并发症。
与对照组相比，我们的发现表明眼外肌后阻滞可减轻儿童斜视手术后早期疼痛的严重程度以及术后呕吐和术中心动眼反射的发生率。
PROSPERO（CRD42015025443）。
