Hamdi Tasrif, Mastari Ekawaty S, Lubis Andriamuri P, Ghozali Imam, Kemalasari Nadia, Harahap Awi Tm
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Department of Anesthesiology and Intensive Care, Adam Malik Hospital, Medan, Indonesia.
Narra J. 2025 Apr;5(1):e1630. doi: 10.52225/narra.v5i1.1630. Epub 2025 Jan 26.
General anesthesia is the standard approach for thoracic and abdominal procedures; however, it has notable limitations, particularly in high-risk patients. Regional anesthesia techniques, such as thoracic segmental spinal anesthesia, have gained popularity due to their potential to reduce these associated risks. The aim of this study was to assess the effectiveness and safety of thoracic segmental spinal anesthesia in breast cancer surgery using systematic review and meta-analysis. This study adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, conducting a comprehensive literature search across ScienceDirect, Cochrane Library, and PubMed databases up to July 4, 2024. The inclusion criteria focused on studies that provided specific information on the effectiveness (postoperative pain reduction) and safety (incidence of adverse events and complications) of thoracic segmental spinal anesthesia, as well as satisfaction among patients and surgeons. Out of 4,060 articles, six studies were included for qualitative assessment, with four further analyzed quantitatively. Meta-analysis findings indicated that thoracic segmental spinal anesthesia provided significantly better pain control at 12 hours postoperatively (SMD: -1.25; 95%CI: -1.54 to -0.96; < 0.0001), although no significant difference was noted at 0 hours (SMD: -1.07; 95%CI: -2.33 to 0.18; = 0.09). Thoracic segmental spinal anesthesia was associated with a lower incidence of postoperative vomiting (RR: 0.46; 95%CI: 0.22-0.95; = 0.04), but it presented a higher risk of hypotension (RR: 2.57; 95%CI: 1.41-4.71; = 0.002). Importantly, no anesthesia-related mortalities were reported. The technique resulted in higher satisfaction levels among both patients (SMD: 0.63; 95%CI: 0.33-0.92; < 0.0001) and surgeons (SMD: 0.81; 95%CI: 0.51-1.11; < 0.0001) compared to general anesthesia. The study highlights that thoracic segmental spinal anesthesia is a safe and effective alternative to general anesthesia for breast cancer surgery, offering superior postoperative pain control, enhanced patient and surgeon satisfaction, and a reduced incidence of postoperative vomiting.
全身麻醉是胸腹部手术的标准方法；然而，它有显著的局限性，尤其是在高危患者中。区域麻醉技术，如胸段脊髓麻醉，因其有可能降低这些相关风险而受到欢迎。本研究的目的是通过系统评价和荟萃分析评估胸段脊髓麻醉在乳腺癌手术中的有效性和安全性。本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）2020指南，在ScienceDirect、Cochrane图书馆和PubMed数据库中进行了全面的文献检索，截至2024年7月4日。纳入标准侧重于提供胸段脊髓麻醉有效性（术后疼痛减轻）和安全性（不良事件和并发症发生率）以及患者和外科医生满意度的具体信息的研究。在4060篇文章中，6项研究被纳入定性评估，其中4项进一步进行定量分析。荟萃分析结果表明，胸段脊髓麻醉在术后12小时提供了显著更好的疼痛控制（标准化均数差：-1.25；95%置信区间：-1.54至-0.96；P<0.0001），尽管在术后0小时未观察到显著差异（标准化均数差：-1.07；95%置信区间：-2.33至0.18；P=0.09）。胸段脊髓麻醉与术后呕吐发生率较低相关（风险比：0.46；95%置信区间：0.22-0.95；P=0.04），但它出现低血压的风险较高（风险比：2.57；95%置信区间：1.41-4.71；P=0.002）。重要的是，未报告与麻醉相关的死亡病例。与全身麻醉相比，该技术在患者（标准化均数差：0.63；95%置信区间：0.33-0.92；P<0.0001）和外科医生（标准化均数差：0.81；95%置信区间：0.51-1.11；P<0.0001）中都产生了更高的满意度。该研究强调，胸段脊髓麻醉是乳腺癌手术中全身麻醉的一种安全有效的替代方法，具有更好的术后疼痛控制、更高的患者和外科医生满意度以及更低的术后呕吐发生率。
