阴茎背神经阻滞与骶管阻滞用于患儿全麻阴茎手术后镇痛效果的比较:meta分析  

Comparison of dorsal penile nerve block and caudal block for postoperative analgesic efficacy in pediatric patients undergoing penile surgery with general anesthesia: a meta-analysis

作　　者：杨桐 郭能起 朱小兵 Yang Tong;Guo Nengqi;Zhu Xiaobing(Department of Anesthesiology,Hospital of Traditional Chinese Medicine of Zhongshan City,Zhongshan 528400,China)

机构地区：[1]广州中医药大学附属中山中医院麻醉科,中山528400

出　　处：《中华麻醉学杂志》2022年第2期186-189,共4页Chinese Journal of Anesthesiology

摘　　要：目的:采用meta分析评价阴茎背神经阻滞(DPNB)与骶管阻滞(CB)用于患儿全麻阴茎手术后镇痛的效果。方法:计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、万方数据库、维普数据库、中国知网数据库和中国生物医学文献数据库,纳入DPNB和CB用于患儿全麻阴茎手术的随机对照试验(RCT),检索年限为建库至2021年9月。采用RevMan 5.4软件进行统计学分析。结果:纳入16项RCT研究,共1271例患儿。meta分析结果显示,CB组复苏期镇痛药物使用率明显低于DPNB组(RR=2.54,95%CI 1.19~5.40,P=0.020);与CB组比较,DPNB组术后首次活动时间明显缩短(SMD=-0.68,95%CI-1.23~-0.13,P=0.020),术后运动阻滞发生率降低(RR=0.05,95%CI 0.01~0.16,P<0.001)。2组术中阻滞失败发生率差异无统计学意义(RR=1.25,95%CI 0.62~2.51,P=0.530),苏醒时(SMD=-0.29,95%CI-0.01~0.59,P=0.050)、术后1 h时(SMD=1.02,95%CI-1.37~3.41,P=0.400)及术后2 h时(SMD=0.05,95%CI-0.59~0.68,P=0.880)客观疼痛评分差异无统计学意义,复苏期躁动发生率差异无统计学意义(RR=0.71,95%CI 0.44~1.14,P=0.150),术后首次排尿时间差异无统计学意义(MD=-84.52,95%CI-195.72~26.69,P=0.140),术后恶心呕吐发生率差异无统计学意义(RR=0.56,95%CI 0.29~1.07,P=0.080)。结论:DPNB用于患儿全麻阴茎手术后镇痛效果与CB相似,但DPNB可避免术后发生下肢运动阻滞,有利于术后康复。Objective To systematically evaluate the efficacy of dorsal penile nerve block(DPNB)and caudal block(CB)for analgesia after penile surgery under general anesthesia in the pediatric patients.Methods Databases including PubMed,EMbase,Web of Science,the Cochrane Library,Wanfang,VIP,CNKI and CBM were searched to collect the randomized controlled trials involving DPNB and CB for penile surgery under general anesthesia in children from inception to September 2021.Meta-analysis was performed using RevMan 5.4 software.Results Sixteen randomized controlled trials involving 1271 pediatric patients were enrolled.The results of meta-analysis showed that the requirement for analgesic drugs during recovery was significantly lower in CB group than in DPNB group(RR=2.54,95%CI 1.19-5.40,P=0.020);the time of first postoperative activity was significantly shortened(SMD=-0.68,95%CI-1.23--0.13,P=0.020),and the incidence of postoperative motor block was decreased(RR=0.05,95%CI 0.01-0.16,P<0.001)in DPNB group as compared with CB group.There were no significant differences in the incidence of intraoperative block failure(RR=1.25,95%CI 0.62-2.51,P=0.530)between two groups.There were no significant differences in objective pain scores at awakening(SMD=-0.29,95%CI-0.01-0.59,P=0.050),at 1 h after surgery(SMD=1.02,95%CI-1.37-3.41,P=0.400),or at 2 h after surgery(SMD=0.05,95%CI-0.59-0.68,P=0.880)between two groups.There were no significant differences in the incidence of agitation during recovery(RR=0.71,95%CI 0.44-1.14,P=0.150)between two groups.There were no significant differences in the time of first urination(MD=-84.52,95%CI-195.72-26.69,P=0.140)between two groups.There were no significant differences in the incidence of postoperative nausea and vomiting(RR=0.56,95%CI 0.29-1.07,P=0.080)between two groups.Conclusions DPNB and CB provide similar postoperative analgesic efficacy,but DPNB can prevent the occurrence of postoperative motor block,which is helpful for the postoperative rehabilitation in the pediatric patients undergoing penile s

关 键 词：麻醉 脊尾 神经传导阻滞 麻醉 全身 儿童 阴茎背神经 META分析 

分 类 号：R726.1[医药卫生—儿科]