Dostbil Aysenur, Kasali Kamber, Aydin Yener, Ince Ilker, Ulas Ali Bilal, Yilmaz Mehmet Akif, Ceren Muhammed, Eroğlu Atilla, Ozgodek Habip Burak, Ozkal Mirac Selcen, Elsharkawy Hesham
Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Türkiye.
Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Oct 30;32(4):419-435. doi: 10.5606/tgkdc.dergisi.2024.26887. eCollection 2024 Oct.
The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques.
In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed.
Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; =97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p<0.001; =0%; fixed effects model) and lower than in LIA (SMD=-1.77; 95% CI, -2.24 to -1.30; Z=7.41; p<0.001; =0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=-2.90; 95% CI, -5.29 to -0.50; Z=2.37; p=0.02; =93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; =0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p<0.001; =0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting.
After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.
本研究旨在比较单次注射前锯肌平面阻滞（SAPB）用于电视辅助胸腔镜手术（VATS）时与其他区域阻滞技术的镇痛效果。
在这项荟萃分析中，回顾了2014年3月24日至2024年3月24日期间发表在PubMed、Scopus、Web of Science、ClinicalKey和PROSPERO电子数据库中的随机对照试验，这些试验比较了SABP与其他区域阻滞在接受VATS的成年患者中的镇痛效果。
本荟萃分析纳入了9项随机对照试验，共537名参与者（男性287名，女性250名；平均年龄：55.2±13.1岁）。将前锯肌平面阻滞与竖脊肌平面阻滞（ESPB）、局部浸润麻醉（LIA）和胸椎旁神经阻滞（TPVB）进行了比较。SAPB术后24小时累积阿片类药物消耗量在统计学上显著高于ESPB（标准化均数差[SMD]=1.98；95%置信区间[CI]，0.23至3.73；Z=2.22；p=0.03；I²=97%；随机效应模型）和TPVB（SMD=0.63；95%CI，0.31至0.96；Z=3.84；p<0.001；I²=0%；固定效应模型），且低于LIA（SMD=-1.77；95%CI，-2.24至-1.30；Z=7.41；p<0.001；I²=0%；固定效应模型）。术后2小时主动疼痛评分在统计学上SAPB显著低于LIA（SMD=-2.90；95%CI，-5.29至-0.50；Z=2.37；p=0.02；I²=93%；随机效应模型）。术后12小时，ESPB的被动疼痛评分（SMD=0.37；95%CI，0.07至0.66；Z=2.41；p=0.02；I²=0%；固定效应模型）和主动疼痛评分（SMD=0.55；95%CI，0.25至0.85；Z=3.60；p<0.001；I²=0%；固定效应模型）在统计学上均显著低于SAPB。SAPB与其他组在术后恶心呕吐发生率方面无差异。
在对术后镇痛效果进行全面评估后，ESPB和TPVB可能比SABP更优，而SABP在VATS患者镇痛方面可能比LIA更优。需要进一步研究以确定VATS中最佳的区域镇痛技术。
