Ciconini Luis Eduardo, Beck Theodoro, Abouelsaad Catreen, Bains Karandip, Carbonar Mauren F
SUNY Downstate Health Sciences University, Department of Anesthesiology, New York, USA.
SUNY Downstate Health Sciences University, Department of Anesthesiology, New York, USA.
Braz J Anesthesiol. 2025 Jan-Feb;75(1):844574. doi: 10.1016/j.bjane.2024.844574. Epub 2024 Nov 17.
Interscalene Brachial Plexus Blocks (ISBPB) are highly effective forms of anesthesia for surgeries involving the upper arm, shoulder, and neck. Recently, there has been a growing interest in comparing the advantages and limitations of the anterior and posterior approaches.
This systematic review and meta-analysis aimed to determine whether the anterior or posterior approach to ISBPB offers a clinical advantage regarding complete block rates and time to block completion. We included randomized controlled trials comparing the anterior and posterior techniques for ISBPB while excluding studies with overlapping populations, comparisons of blocks other than interscalene, and articles written in a non-English language.
The search strategy identified 2229 articles, of which six Randomized Controlled Trials (RCTs) met the inclusion criteria for the meta-analysis. A total of 414 patients were included, with 210 patients in the anterior group and 204 in the posterior group. The Odds Ratio (OR) for a complete sensory block between the two techniques did not reach statistical significance (OR = 0.56 [0.20, 1.58], 95% CI, p = 0.27). Similarly, the Standardized Mean Difference (SMD) for the time to complete the block also did not reach statistical significance (SMD: -0.77 [-2.12, 0.59], 95% CI, p = 0.27). Heterogeneity for complete block was not significant (I = 0%), while procedure time showed high heterogeneity (I = 97%).
Both techniques have shown effectiveness in providing surgical analgesia. The choice of technique should be determined by the provider's comfort and proficiency, as well as ensuring the highest level of safety for the patient.
肌间沟臂丛神经阻滞（ISBPB）是用于上臂、肩部和颈部手术的高效麻醉方式。近来，人们对比较前路和后路方法的优缺点兴趣日增。
本系统评价和荟萃分析旨在确定ISBPB的前路或后路方法在完全阻滞率和阻滞完成时间方面是否具有临床优势。我们纳入了比较ISBPB前路和后路技术的随机对照试验，同时排除了有重叠人群的研究、肌间沟以外阻滞的比较以及非英文撰写的文章。
检索策略共识别出2229篇文章，其中六项随机对照试验（RCT）符合荟萃分析的纳入标准。总共纳入414例患者，前路组210例，后路组204例。两种技术之间完全感觉阻滞的优势比（OR）未达到统计学显著性（OR = 0.56 [0.20, 1.58]，95%置信区间，p = 0.27）。同样，阻滞完成时间的标准化均差（SMD）也未达到统计学显著性（SMD: -0.77 [-2.12, 0.59]，95%置信区间，p = 0.27）。完全阻滞的异质性不显著（I² = 0%），而操作时间显示出高度异质性（I² = 97%）。
两种技术在提供手术镇痛方面均显示出有效性。技术的选择应由术者的舒适度和熟练程度决定，同时要确保为患者提供最高水平的安全保障。
