Xue Xing, Zhou Yuxin, Yu Na, Yang Zhihua
Department of Anesthesiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Front Pediatr. 2024 Aug 2;12:1417265. doi: 10.3389/fped.2024.1417265. eCollection 2024.
Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children.
A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation.
The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability.
Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity.
PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).
尽管区域阻滞镇痛已被公认具有诸多益处，但对于小儿疝气手术而言，选择最佳的区域阻滞方法仍存在争议。本研究旨在对随机临床试验进行网状Meta分析和系统评价，旨在整合直接和间接比较的结果，以了解儿童腹股沟疝修补术后各种区域阻滞的镇痛效果和安全性。
由两名独立的评审人员按照标准化方案，于2022年11月12日前在PubMed、EMBASE、Web of Science和Cochrane图书馆进行了全面的文献检索。纳入标准包括聚焦于采用局部浸润镇痛或区域镇痛进行腹股沟疝修补术儿童的随机试验。评估的主要结局为术后2、6和24小时的疼痛评分。
初步检索得到281条与1137例患者相关的记录。排序概率分析表明，椎旁阻滞（PVB）在术后2小时和6小时缓解疼痛方面最有效的可能性最高（分别为88%和48%）。腹横肌平面阻滞（TAPB）是术后24小时减轻疼痛（83%）和减少吗啡用量（93%）的更佳选择。局部麻醉浸润（LAI）被确定为缩短住院时间最有效的方法，概率为90%。
区域麻醉显著改善了小儿腹股沟疝修补手术的术后疼痛管理。对于术后短期疼痛缓解，PVB是最有效的技术。同时，TAPB提供更持久的镇痛效果。尽管TAPB在短期镇痛方面没有明显优势，但其操作简单且无需特殊体位，使其成为一个可行的选择。然而，由于数据有限和存在异质性，对这些结果的解释应谨慎。
PROSPERO（CRD42022376435；www.crd.york.ac.uk/prospero）
