School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Anesthesiol. 2024 Oct 29;24(1):389. doi: 10.1186/s12871-024-02775-4.
Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries.
We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model.
ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis.
ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile.
Prospero registration ID: CRD42024508363. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
竖脊肌平面阻滞（ESPB）是一种新的镇痛技术，可减少腹腔镜手术的术后疼痛和术后阿片类药物的使用。
我们于 2023 年 11 月 17 日在 PubMed、Scopus 和 Web of Science 上检索了比较 ESPB 与其他镇痛技术或安慰剂用于腹腔镜手术的临床试验。我们使用随机效应模型对术后静息时的疼痛、术后阿片类药物的使用、首次需要镇痛补救的时间和术后恶心呕吐进行荟萃分析。
与安慰剂相比，ESPB 显著减少了阿片类药物的使用（SMD，（95CI），p 值；-1.837，（-2.331，-1.343），<0.001），也显著减少了与腹横肌平面阻滞（TAPB）相比（SMD，（95CI），p 值；-1.351，（-1.815，-0.877），<0.001），但与竖脊肌平面阻滞（QLB）相比没有统计学意义（SMD，（95CI），p 值；0.022，（-0.241，0.286），0.869）。ESPB 还显著降低了术后 24 小时参与者报告的静息疼痛评分与安慰剂相比（SMD，（95CI），p 值；-0.612，（-0.797，-0.428），<0.001）和 TAPB 相比（SMD，（95CI），p 值；-0.465，（-0.767，-0.162），<0.001），然而，与 QLB 相比，疼痛评分有显著增加（SMD，（95CI），p 值；1.025，0.156，1.894），0.021）。我们的荟萃分析观察到，与安慰剂和 TAPB 组相比，ESPB 组首次需要镇痛补救的时间有显著增加。与安慰剂组相比，ESPB 组术后恶心呕吐发生率较低，但与 QLB 和 TAPB 组相比，发生率相似。
与安慰剂相比，ESPB 是一种有效的、安全的腹腔镜手术术后镇痛技术，可减少术后疼痛和阿片类药物的使用，同时降低术后恶心呕吐的发生率。与其他技术相比，ESPB 与 QLB 的疗效相似，除了术后 24 小时的疼痛评分，但作为腹腔镜手术的镇痛技术，它似乎优于 TAPB，具有相似的安全性。
Prospéro 注册号：CRD42024508363。链接：https://www.crd.york.ac.uk/PROSPERO/#recordDetails。
