颈椎手术中颈椎水平区域性椎旁神经阻滞：随机对照试验的系统评价和荟萃分析。
Cervical-Level Regional Paraspinal Nerve Block in Cervical Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
机构信息
Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Faculty of Medicine, Department of Anesthesiology and Intensive Care, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia.
出版信息
World Neurosurg. 2024 Oct;190:470-480.e2. doi: 10.1016/j.wneu.2024.08.021. Epub 2024 Aug 8.
BACKGROUND
Regional paraspinal nerve block techniques have shown promise in cervical spine surgery pain relief and opioid reduction. The study aims to evaluate cervical-level regional paraspinal nerve block techniques in cervical spine surgery.
METHODS
Systematic randomized controlled trial (RCT) searches in ScienceDirect, PubMed, Embase, and Cochrane was conducted until March 2024. Key outcome measures included postoperative pain scores and postoperative opioid utilization. Techniques assessed were erector spinae plane block (ESPB), inter-semispinal plane block (ISPB), and superficial cervical plexus block (CPB).
RESULTS
The study included 6 RCTs and 648 participants. Regional paraspinal nerve block significantly reduced postoperative pain scores at 4, 6, 8, 12, and 24 hours. Postoperative opioid usage was lower in the block group (mean difference [MD]: -1.68; 95% CI: -3.14 to -0.21; P = 0.02), with fewer complications (odds ratio: 0.51; 95% CI: 0.40-0.66; P = 0.001). Patients using fentanyl as postoperative opioid had significantly lower opioid usage with the block (MD: -1.39; 95% CI: -1.76 to -1.01; P < 0.001). Dosage >10 mL correlated with decreased opioid usage (MD: -2.78; 95% CI: -5.25 to -0.31; P < 0.001). ESPB (MD: -1.37; 95% CI: -1.83 to -0.90; P < 0.001) and ISPB (MD: -3.52; 95% CI: -7.09-0.00; P = 0.05) effectively reduced opioid consumption. Posterior approach (MD: -2.78; 95% CI: -5.25 to -0.31; P < 0.001), bilateral administration (MD: -2.14; 95% CI: -4.26 to -0.03; P < 0.001), and ultrasound-guided intervention (MD: -2.68; 95% CI: -5.24 to -0.12; P < 0.001) resulted in a significant reduction of opioid usage.
CONCLUSIONS
Cervical-level regional paraspinal nerve block effectively reduces postoperative pain and opioid usage, particularly with a dosage exceeding 10 mL, utilizing ESPB and ISPB techniques, administered posteriorly, bilaterally, and under ultrasound guidance.
背景
区域椎旁神经阻滞技术在颈椎手术疼痛缓解和减少阿片类药物使用方面显示出前景。本研究旨在评估颈椎水平区域椎旁神经阻滞技术在颈椎手术中的应用。
方法
在 ScienceDirect、PubMed、Embase 和 Cochrane 中进行系统的随机对照试验 (RCT) 检索，检索时间截至 2024 年 3 月。主要结局指标包括术后疼痛评分和术后阿片类药物使用情况。评估的技术包括竖脊肌平面阻滞 (ESPB)、半棘肌间平面阻滞 (ISPB) 和颈浅丛阻滞 (CPB)。
结果
本研究纳入了 6 项 RCT 和 648 名参与者。椎旁神经阻滞显著降低了术后 4、6、8、12 和 24 小时的疼痛评分。阻滞组术后阿片类药物使用量较低（平均差值 [MD]：-1.68；95%置信区间：-3.14 至 -0.21；P = 0.02），并发症更少（比值比：0.51；95%置信区间：0.40-0.66；P = 0.001）。使用芬太尼作为术后阿片类药物的患者使用阻滞时阿片类药物使用量显著降低（MD：-1.39；95%置信区间：-1.76 至 -1.01；P < 0.001）。剂量>10 mL 与阿片类药物使用量减少相关（MD：-2.78；95%置信区间：-5.25 至 -0.31；P < 0.001）。ESPB（MD：-1.37；95%置信区间：-1.83 至 -0.90；P < 0.001）和 ISPB（MD：-3.52；95%置信区间：-7.09 至 0.00；P = 0.05）有效减少了阿片类药物的消耗。后路入路（MD：-2.78；95%置信区间：-5.25 至 -0.31；P < 0.001）、双侧给药（MD：-2.14；95%置信区间：-4.26 至 -0.03；P < 0.001）和超声引导干预（MD：-2.68；95%置信区间：-5.24 至 -0.12；P < 0.001）可显著减少阿片类药物的使用。
结论
颈椎水平区域椎旁神经阻滞可有效减轻术后疼痛和阿片类药物使用，特别是剂量超过 10 mL 时，采用 ESPB 和 ISPB 技术，后路、双侧和超声引导下给药效果更好。
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