Shaikh Samiullah, Banatwala Umm E Salma Shabbar, Desai Paranshi, Khan Muhammad Arham, Bint-E-Hina Rimsha, Samad Sidra, Sikandari Muhammad Hamza, Nawaz Ali, Ijaz Rana, Asmat Shayan, Fatima Abeer, Mirza Harim, Azam Noor Mahal, Muhammad Qurat Ul Ain, Kumar Satesh, Khatri Mahima
Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
Dow University of Health Sciences, Karachi, Pakistan.
J Anesth Analg Crit Care. 2024 Dec 18;4(1):82. doi: 10.1186/s44158-024-00218-7.
Mastectomy and breast-conserving surgery are key interventions for breast cancer, a leading cause of cancer-related mortality in women. Many undergoing breast surgery experience postoperative pain compromising their functionality and quality of life. While multiple pain management strategies are available, evidence comparing the erector spinae (ESPB) and serratus anterior plane blocks (SAPB) for improving post-surgical pain management in breast cancer surgery patients is limited. Therefore, we investigated the efficacy and safety of these two regional anesthesia techniques.
After PROSPERO registration, we systematically searched PubMed, Google Scholar, and Cochrane Library until May 2024. Risk ratios (RR) were calculated for dichotomous outcomes and standard mean differences (SMD) or mean differences (MD) were computed for continuous data. RevMan Review Manager 5.4.1 was used for the data analysis and generation of forest plots as well as funnel plots. The Cochrane Risk of Bias tool 2.0 (18) and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines were used to appraise and evaluate the evidence (19).
A total of 9 randomized control trials enrolling 550 patients were included. Static pain scores at 0, 6, 8, 12, and 24 h after surgery, dynamic pain scores computed at 0, 8, 12, and 24 h after surgery and area under the curve (AUC) static pain score at all time points between 0 and 24 h (SMD (HKSJ 95% CI) - 0.27 [- 0.99, 0.45]) did not significantly vary with either plane block. Postoperative morphine consumption in the first 24 h and the number of patients requesting analgesia were significantly greater in those receiving SAPB [MD: - 1.41 (95% C.I. - 2.70, - 0.13), p = 0.03] and [RR: 1.28 (95% C.I. 1.00, 1.63), p = 0.05], respectively. The time to first postoperative analgesic use was significantly greater among those administered ESPB [MD: 1.55 h, (95% C.I. 1.02, 2.09), p < 0.01]. Patient satisfaction scores and the incidence of nausea and vomiting were similar across both groups.
While pain scores with either block are comparable, ESPB reduces postoperative morphine consumption and may be the favorable option in breast cancer patients undergoing surgery.
乳房切除术和保乳手术是乳腺癌的关键干预措施，乳腺癌是女性癌症相关死亡的主要原因。许多接受乳房手术的患者会经历术后疼痛，这会影响他们的功能和生活质量。虽然有多种疼痛管理策略，但比较竖脊肌平面阻滞（ESPB）和前锯肌平面阻滞（SAPB）对改善乳腺癌手术患者术后疼痛管理效果的证据有限。因此，我们研究了这两种区域麻醉技术的有效性和安全性。
在PROSPERO注册后，我们系统检索了PubMed、谷歌学术和Cochrane图书馆，直至2024年5月。计算二分结果的风险比（RR），并计算连续数据的标准化均数差（SMD）或均数差（MD）。使用RevMan Review Manager 5.4.1进行数据分析以及生成森林图和漏斗图。使用Cochrane偏倚风险工具2.0和推荐分级、评估、制定与评价（GRADE）指南对证据进行评估。
共纳入9项随机对照试验，涉及550例患者。术后0、6、8、12和24小时的静态疼痛评分、术后0、8、12和24小时计算的动态疼痛评分以及0至24小时所有时间点的曲线下面积（AUC）静态疼痛评分（SMD（HKSJ 95%CI）−0.27[−0.99, 0.45]）在两种平面阻滞中均无显著差异。接受SAPB的患者在术后24小时内的吗啡消耗量和要求镇痛的患者人数显著更多，分别为[MD：−1.41（95%CI−2.70，−0.13），p = 0.03]和[RR：1.28（95%CI 1.00，1.63），p = 0.05]。接受ESPB的患者首次使用术后镇痛药的时间显著更长[MD：1.55小时，（95%CI 1.02，2.09），p < 0.01]。两组患者的满意度评分以及恶心和呕吐的发生率相似。
虽然两种阻滞的疼痛评分相当，但ESPB可减少术后吗啡消耗量，可能是接受手术的乳腺癌患者的更佳选择。
