Department of Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Monglia, China.
Medicine (Baltimore). 2024 Oct 25;103(43):e40152. doi: 10.1097/MD.0000000000040152.
The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries.
We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity.
Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = -0.43; 95% CI = -0.77 to -0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = -0.05 to 0.39), block performance time (SMD = -0.14; 95% CI = -0.51 to 0.22), onset of sensory blockade (SMD = -0.13; 95% CI = -0.59 to 0.33) and onset of motor blockade (SMD = -0.17; 95% CI = -0.26 to 0.12). No high heterogeneity was seen among the included studies.
Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.
锁骨下与锁骨上神经阻滞对上肢手术的镇痛效果尚不清楚。本 meta 分析和系统评价旨在研究锁骨下与锁骨上神经阻滞对上肢手术的镇痛效果。
我们检索了多个数据库，包括 PubMed、EMbase、Web of Science、EBSCO 和 Cochrane 图书馆数据库，从建库至 2023 年 12 月，并纳入了评估锁骨下与锁骨上神经阻滞对上肢手术效果的随机对照试验（RCT）。我们排除了报告其他神经阻滞方法的研究。使用改良 Jadad 量表评估纳入研究的方法学质量。使用标准均数差（SMD）和 95%置信区间（CI）评估连续结局。本 meta 分析采用固定效应模型或随机效应模型，取决于异质性。
纳入了 8 项 RCT 和 725 名患者。与锁骨上神经阻滞相比，锁骨下神经阻滞可显著延长运动阻滞时间（SMD=0.34；95%CI=0.12 至 0.56）和减少手术准备时间（SMD=-0.43；95%CI=-0.77 至 -0.10），但感觉阻滞时间（SMD=0.17；95%CI=-0.05 至 0.39）、阻滞起效时间（SMD=-0.14；95%CI=-0.51 至 0.22）、感觉阻滞起效时间（SMD=-0.13；95%CI=-0.59 至 0.33）和运动阻滞起效时间（SMD=-0.17；95%CI=-0.26 至 0.12）无显著差异。纳入研究之间无高度异质性。
锁骨下神经阻滞可能优于锁骨上神经阻滞控制上肢手术的镇痛效果。
