重新定义疼痛管理：探讨竖脊肌平面阻滞和斜肋下腹横肌平面阻滞在腹腔镜胆囊切除术中的有效性和安全性——一项随机对照试验的荟萃分析

Redefining pain management: investigating the efficacy and safety of erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a meta analysis of randomized controlled trials.

作者信息

Saleem Syed Zia, Akhtar Syed Muhammad Muneeb, Fareed Areeba, Shaik Afsana Ansari, Asghar Muhammad Sohaib

机构信息

Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.

Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.

出版信息

BMC Anesthesiol. 2025 Apr 16;25(1):182. doi: 10.1186/s12871-025-03059-1.

DOI:10.1186/s12871-025-03059-1

PMID:40240902

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12001665/

Abstract

BACKGROUND

Pain following laparoscopic cholecystectomy plays a pivotal role in determining the quality of patient recovery. Considering the opioid crisis, exploration of alternative approaches, such as regional blocks, including erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane block (OSTAPB), has garnered considerable attention due to their promising outcomes in clinical trials.

OBJECTIVE

Our aim is to provide a robust analysis which reflects the most current evidence for the effectiveness and safety of ESPB by comparing it to OSTAPB in adult patients undergoing laparoscopic cholecystectomy.

METHODS

An extensive search was performed in the PubMed, Medline, and Cochrane Library databases from inception to June 1st 2023. Mean difference (SMD), and 95% confidence intervals (CIs) were calculated for continuous outcomes, Risk ratios (RR) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.

RESULTS

A total of 5 RCTs including 372 participants were included in this meta-analysis. Pooled analysis of overall postoperative pain scores at 12 and 24 h showed ESPB to be superior to OSTAPB [MD = -0.67; 95% CI: (-0.95 to -0.39); p < 0.001, I = 72%]. ESPB also showed significantly lesser opioid consumption at 24 h postoperatively [MD = -5.36; 95% CI: (-8.56 to -2.15); p < 0.001, I = 96%], while intraoperative opioid consumption {MD = -0.46; 95% CI: (-1.27 to -0.36); p = 0.27, I = 0%} and postoperative nausea and vomiting were not significantly different between the two groups {RR = 0.40, 95% CI (0.10 to 1.56), p = 0.19; I = 56%}.

CONCLUSION

In summary, the erector spinae plane block (ESPB) appears to be the preferred option for acute postoperative pain and opioid reduction in adults undergoing laparoscopic cholecystectomy.

摘要

背景

腹腔镜胆囊切除术后的疼痛在决定患者恢复质量方面起着关键作用。鉴于阿片类药物危机，探索替代方法，如区域阻滞，包括竖脊肌平面阻滞（ESPB）和斜肋下腹横肌平面阻滞（OSTAPB），因其在临床试验中的良好结果而备受关注。

目的

我们的目的是通过将ESPB与OSTAPB在接受腹腔镜胆囊切除术的成年患者中进行比较，提供一项有力的分析，以反映ESPB有效性和安全性的最新证据。

方法

从数据库建立至2023年6月1日，在PubMed、Medline和Cochrane图书馆数据库中进行了广泛检索。连续结果计算平均差（SMD）和95%置信区间（CI），二分结果计算风险比（RR）。所有统计分析均使用R统计软件和meta包v4.17 - 0进行。

结果

本荟萃分析共纳入5项随机对照试验，包括372名参与者。对术后12小时和24小时总体疼痛评分的汇总分析显示，ESPB优于OSTAPB [MD = -0.67；95% CI：（-0.95至-0.39）；p < 0.001，I = 72%]。ESPB在术后24小时的阿片类药物消耗量也显著较少[MD = -5.36；95% CI：（-8.56至-2.15）；p < 0.001，I = 96%]，而术中阿片类药物消耗量{MD = -0.46；95% CI：（-1.27至-0.36）；p = 0.27，I = 0%}以及术后恶心呕吐在两组之间无显著差异{RR = 0.40，95% CI（0.10至1.56），p = 0.19；I = 56%}。