单次注射前锯肌平面阻滞与胸椎旁神经阻滞在乳腺和胸科手术中的围手术期镇痛效果比较——一项随机对照试验的系统评价和荟萃分析

Relative perioperative analgesic efficacy of single-shot serratus anterior plane block versus thoracic paravertebral block in breast and thoracic surgeries - A systematic review and meta-analysis of randomised controlled trials.

作者信息

Makkar Jeetinder K, Singh Narinder P, Khurana Bisman Jeet Kaur, Singh Preet M

机构信息

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Department of Anesthesia and Pain Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada.

出版信息

Indian J Anaesth. 2025 Jan;69(1):54-64. doi: 10.4103/ija.ija_1027_24. Epub 2025 Jan 11.

BACKGROUND AND AIMS

Various regional analgesia techniques, such as thoracic paravertebral (TPV) and serratus anterior plane (SAP) blocks, have been employed to manage postoperative pain following chest wall surgery. However, the comparative analgesic efficacy of these two approaches remains uncertain. This systematic review and meta-analysis aimed to assess the relative analgesic efficacy of these blocks in chest wall surgeries, including breast and thoracic procedures. The primary objective was the time to first rescue analgesia, and the secondary objective encompassed opioid consumption within 24 h, pain scores at different time intervals, opioid-related adverse effects and block-related complications.

METHODS

A systematic search for randomised controlled trials (RCTs) was conducted in PubMed, EMBASE and Scopus databases, covering studies from their inception to September 2023. We included active treatment arms from RCTs comparing these analgesic modalities. Statistical analysis was conducted in Review Manager Version 5.3, and results were analysed and reported separately for breast and thoracic surgery subgroups.

RESULTS

Eighteen trials enroling 1141 patients were included. Overall, no significant difference was observed in time to rescue analgesia, with a mean difference of 0.69 h (95% confidence interval -1.83, 0.45; = 0.24, = 98%) between the SAP and TPV block groups. However, the TPV block demonstrated superior results for secondary outcomes in thoracic surgery patients. Complications related to the TPV block included pleural puncture and haematoma at the injection site.

CONCLUSIONS

The evidence suggests that both blocks generally offer comparable analgesic efficacy for chest wall surgery patients, with the TPV block providing a slight advantage for those undergoing thoracic surgery.

背景与目的

多种区域镇痛技术，如胸椎旁（TPV）阻滞和前锯肌平面（SAP）阻滞，已被用于处理胸壁手术后的疼痛。然而，这两种方法的相对镇痛效果仍不确定。本系统评价和荟萃分析旨在评估这些阻滞在胸壁手术（包括乳腺和胸部手术）中的相对镇痛效果。主要目标是首次补救镇痛的时间，次要目标包括24小时内的阿片类药物消耗量、不同时间间隔的疼痛评分、阿片类药物相关不良反应和阻滞相关并发症。

方法

在PubMed、EMBASE和Scopus数据库中对随机对照试验（RCT）进行系统检索，涵盖从数据库建立至2023年9月的研究。我们纳入了比较这些镇痛方式的RCT的积极治疗组。使用Review Manager 5.3版进行统计分析，并分别对乳腺和胸部手术亚组的结果进行分析和报告。

结果

纳入了18项试验，共1141例患者。总体而言，在补救镇痛时间上未观察到显著差异，SAP阻滞组和TPV阻滞组之间的平均差异为0.69小时（95%置信区间-1.83，0.45；P = 0.24，I² = 98%）。然而，TPV阻滞在胸部手术患者的次要结局方面显示出更好的结果。与TPV阻滞相关的并发症包括胸膜穿刺和注射部位血肿。