Wang Rong, Ju Jinlong, Pang Xiaoyi
Department of Anesthesiology, Mianyang 404 Hospital, Mianyang, Sichuan, China.
Department of Anesthesiology, Sichuan Science City Hospital, Mianyang, Sichuan, China.
Front Med (Lausanne). 2025 Aug 18;12:1580172. doi: 10.3389/fmed.2025.1580172. eCollection 2025.
This meta-analysis investigates the efficacy and safety of ultrasound-guided nerve block in geriatric surgical patients, a crucial endeavor for optimizing anesthetic protocols and enhancing perioperative medical outcomes and prognostic indices in this vulnerable patient cohort.
A comprehensive literature search was conducted in major bibliographic databases, including Web of Science, PubMed, The Cochrane Library, Embase, CNKI, Wan Fang, and VIP, to identify studies investigating the utilization of ultrasound-guided nerve blocks in elderly surgical patients. The search encompassed publications from database inception to January 2025. Two independent reviewers meticulously screened the retrieved literature, extracted relevant data, and assessed the risk of bias inherent in the included studies. Subsequently, a meta-analysis was performed to synthesize the findings.
Twenty-five randomized trials were included in the analysis, The meta-analysis showed that, Compared with the control group, Ultrasound-guided nerve block Blocking effective rate ([RR = 1.21 (1.11, 1.31), < 0.001], time of onset of sensory nerve block [SMD = -2.76 (-3.67, -1.85), < 0.001] and Duration [SMD = 2.52 (1.86, 3.18), < 0.01]; Time to onset of motor nerve block [SMD = -1.94 (-2.68,-1.19), < 0.001], and Duration [SMD = 1.11 (0.24, 1.98), = 0.01] has a good effect. After the ultrasound-guided nerve block group, 4 [SMD = -1.68 (-2.68, -0.68), < 0.001], 8 [SMD = -0.99 (-1.66, -0.32), < 0.001], 12 [SMD = -1.03 (-1.0.48, -0.58), < 0.001], 24 [SMD = -1.56 (-2.36, -0.75), < 0.001] hours had all lower VAS scores than the control group. The Adverse reaction rate in the experimental group was 0.35 times that of the control group [RR = 0.35 (0.23, 0.55), < 0.001] and no significant difference between the operating groups [SMD = 0.25 (-0.36, 0.86), = 0.43]. Significant publication bias was found except for the duration of the motor nerve block and surgery time. Sensitivity analysis confirmed the stability of the results.
Ultrasound-guided nerve blocks constitute an efficacious and safe anesthetic modality for elderly surgical patients. These findings have significant implications for the refinement of anesthetic protocols within the geriatric population, with the potential to enhance perioperative medical quality and patient outcomes. The evidence presented in this meta-analysis provides a robust foundation for the widespread adoption of ultrasound-guided nerve blocks in clinical practice for elderly surgical patients.
本荟萃分析旨在研究超声引导下神经阻滞在老年外科手术患者中的有效性和安全性，这对于优化麻醉方案、改善这一脆弱患者群体的围手术期医疗结局和预后指标至关重要。
在主要文献数据库中进行全面的文献检索，包括Web of Science、PubMed、Cochrane图书馆、Embase、中国知网、万方和维普，以识别研究超声引导下神经阻滞在老年外科手术患者中应用的研究。检索涵盖从数据库建立到2025年1月的出版物。两名独立评审员仔细筛选检索到的文献，提取相关数据，并评估纳入研究中固有的偏倚风险。随后进行荟萃分析以综合研究结果。
分析纳入了25项随机试验。荟萃分析表明，与对照组相比，超声引导下神经阻滞的阻滞有效率[RR = 1.21(1.11, 1.31)，P < 0.001]、感觉神经阻滞起效时间[SMD = -2.76(-3.67, -1.85)，P < 0.001]和持续时间[SMD = 2.52(1.86, 3.18)，P < 0.01]；运动神经阻滞起效时间[SMD = -1.94(-2.68, -1.19)，P < 0.001]和持续时间[SMD = 1.11(0.24, 1.98)，P = 0.01]效果良好。超声引导下神经阻滞组在4[SMD = -1.68(-2.68, -0.68)，P < 0.001]、8[SMD = -0.99(-1.66, -0.32)，P < 0.001]、12[SMD = -1.03(-1.48, -0.58)，P < 0.001]、24[SMD = -1.56(-2.36, -0.75)，P < 0.001]小时时的视觉模拟评分（VAS）均低于对照组。实验组的不良反应发生率是对照组的0.35倍[RR = 0.35(0.23, 0.55)，P < 0.001]，各手术组之间无显著差异[SMD = 0.25(-0.36, 0.86)，P = 0.43]。除运动神经阻滞持续时间和手术时间外，发现存在显著的发表偏倚。敏感性分析证实了结果的稳定性。
超声引导下神经阻滞是老年外科手术患者一种有效且安全的麻醉方式。这些发现对于完善老年人群的麻醉方案具有重要意义，有可能提高围手术期医疗质量和患者结局。本荟萃分析提供的证据为超声引导下神经阻滞在老年外科手术患者临床实践中的广泛应用奠定了坚实基础。
