左旋布比卡因与罗哌卡因用于臂丛神经阻滞：随机对照试验的系统评价和荟萃分析

Levobupivacaine versus ropivacaine for brachial plexus block: A systematic review and meta-analysis of randomised controlled trials.

作者信息

Alharran Abdullah M, Alotaibi Muteb N, Alenezi Yaqoub Y, Alharran Yousef M, Alahmad Ahmad A, Alqallaf Abdulmuhsen, Al-Mutairi Mohammad F, Saad Abdulbadih R, Alazemi Mohammed H, Saif Duaij S, Albazee Ebraheem, Almohammad Ahmad Y

机构信息

Department of Medicine and Surgery, Arabian Gulf University, Manama, Kingdom of Bahrain.

Department of Medicine and Surgery, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.

出版信息

Indian J Anaesth. 2025 Feb;69(2):179-190. doi: 10.4103/ija.ija_1156_24. Epub 2025 Jan 29.

DOI:10.4103/ija.ija_1156_24

PMID:40160909

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11949393/

Abstract

BACKGROUND AND AIMS

Brachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery.

METHODS

A systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I statistic.

RESULTS

Sixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), < 0.001] and motor block duration [MD: 1.18 (95% CI: 0.11, 2.26), = 0.03]. However, there was no difference between both groups in time to sensory block [MD: -0.30 (95% CI: -1.31, 0.71), = 0.56], time to motor block [MD: -0.29 (95% CI: -1.26, 0.67), = 0.55], pain score [MD: -0.48 (95% CI: -2.13, 1.16), = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), = 0.09].

CONCLUSIONS

Levobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.

摘要

背景与目的

臂丛神经阻滞（BPB）对于择期骨科或上肢重建手术具有优势。然而，BPB中最佳的局部麻醉药仍存在争议。因此，我们旨在研究左旋布比卡因与罗哌卡因用于上肢手术BPB的有效性和安全性。

方法

进行一项系统评价和荟萃分析，综合自数据库创建至2024年6月通过系统检索PubMed、EMBASE、WOS、SCOPUS、谷歌学术和CENTRAL获取的随机对照试验（RCT）。使用Stata v. 17软件，采用均数差（MD）和风险比（RR）合并连续和二分结局变量，并给出95%置信区间（CI）。我们使用卡方检验和I统计量评估异质性。

结果

纳入16项RCT和939例患者。左旋布比卡因与更长的感觉阻滞持续时间显著相关[MD：1.66（95%CI：1.43，1.89），P<0.001]和运动阻滞持续时间[MD：1.18（95%CI：0.11，2.26），P = 0.03]。然而，两组在感觉阻滞时间[MD：-0.30（95%CI：-1.31，0.71），P = 0.56]、运动阻滞时间[MD：-0.29（95%CI：-1.26，0.67），P = 0.55]、疼痛评分[MD：-0.48（95%CI：-2.13，1.16），P = 0.56]、补救镇痛率[RR：0.94（95%CI：0.74，1.20），P = 0.64]和并发症[RR：0.47（95%CI：0.20，1.13），P = 0.09]方面无差异。