竖脊肌平面阻滞与前锯肌平面阻滞用于胸部手术患者术后镇痛及恢复效果的meta分析  

Effects of erector spinae plane block and serratus anterior plane blockon postoperative analgesia and recovery in patients withthoracic surgery:a meta analysis

作　　者：先仙 谈程 周航 姚昊[1] XIAN Xian;TAN Cheng;ZHOU Hang;YAO Hao(Department of Anesthesiology,Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)

机构地区：[1]南京医科大学第二附属医院麻醉科,南京210011

出　　处：《重庆医学》2024年第9期1371-1377,共7页Chongqing medicine

基　　金：江苏省科技厅省级重点研发计划(社会发展)面上项目(BE2021748)。

摘　　要：目的通过meta分析比较竖脊肌平面阻滞(ESPB)和前锯肌平面阻滞(SAPB)对胸部手术患者术后镇痛及恢复时间的影响。方法计算机系统检索Pubmed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普数据库,收集2013年1月1日至2023年6月1日发表的关于ESPB和SAPB对胸部手术患者术后镇痛影响的研究。采用RevMan5.4软件对收集的数据进行汇总分析。结果共纳入13项随机对照试验(RCT)共929例患者,其中ESPB组464例,SAPB组465例。两组患者术后1、2、6、8、12、24、48 h的静息视觉模拟量表(VAS)评分及术后第2、4、8、12小时的活动VAS评分差异均无统计学意义(P>0.05)。两组术后4 h静息VAS评分差异有统计学意义(MD=-0.15,95%CI:-0.24~-0.06,P<0.01)。两组术后24 h活动VAS评分差异有统计学意义(MD=0.74,95%CI:0.01~1.48,P=0.05)。两组术后48 h镇痛泵有效按压次数差异有统计学意义(MD=-0.19,95%CI:-0.36~0.02,P=0.03)。两组术后48 h阿片类药物用量差异无统计学意义(MD=-5.32,95%CI:-11.76~1.13,P=0.11)。两组术后镇痛相关不良事件发生率,术后恶心呕吐与术后皮肤瘙痒发生率差异无统计学意义(MD=1.07,95%CI:0.85~1.34,P=0.58;MD=0.86,95%CI:0.53~1.40,P=0.56)。两组患者术后首次下床时间(MD=-0.01,95%CI:-0.04~0.05,P=0.81)、术后进食时间(MD=-0.22,95%CI:-0.84~0.40,P=0.49)、术后住院时间(MD=-0.07,95%CI:-0.64~0.51,P=0.82)比较差异均无统计学意义。结论SAPB和ESPB作为胸部手术患者的术后镇痛方法,均能提供良好的镇痛效果,推荐优先选用ESPB作为胸部手术患者术后镇痛的方案。Objective To compare the effects of erector spinae plane block(ESPB)and serratus anterior plane block(SAPB)on postoperative analgesia and recovery time in the patients with thoracic surgery by the meta analysis.Methods The databases of Pubmed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang and VIP were systematically retrieved by computer.The studies on the effect of ESPB and SAPB for postoperative analgesia in the patients with thoracic surgery published from January 1,2013 to now were collected.The RevMan5.4 software was used to conduct the summary analysis.Results A total of 13 randomized controlled trials(RCT)involving 929 patients were included,including 464 cases in the ESPB group and 465 cases in the SAPB group.There was no statistically significant difference in the VAS pain scores at rest at postoperative 1,2,6,8,12,24,48 h and during activity at postoperative 2,4,8,12 h between the two groups(P>0.05).The rest VAS score at postoperative 4 h had statistical difference between the ESPB group and SAPB group(MD=-0.15,95%CI:-0.24 to-0.06,P<0.01).The activity VAS scores at postoperative 24 h had statistical difference between the ESPB group and SAPB group(MD=0.74,95%CI:0.01-1.48,P=0.05).There was statistically significant difference in the effective pressing times of analgesic pump at postoperative 48 h between the two groups(MD=-0.19,95%CI:-0.36-0.02,P=0.03).There was no statistically significant difference in the use amount of opioids drugs at postoperative 48 h between the two groups(MD=-5.32,95%CI:-11.76-1.13,P=0.11).There was no statistically significant difference in the incidence rates of postoperative analgesia-related adverse events,nausea and vomiting and skin pruritus between the two groups(MD=1.07,95%CI:0.85-1.34,P=0.58;MD=0.86,95%CI:0.53-1.40,P=0.56).The first time out of bed after surgery(MD=-0.01,95%CI:-0.04-0.05,P=0.81),postoperative eating time(MD=-0.22,95%CI:-0.84-0.40,P=0.49)and postoperative hospitalization stay duration(MD=-0.07,95%CI:-0.64-0.51,P=0.82)had no statistical differences be

关 键 词：竖脊肌平面阻滞 前锯肌平面阻滞 术后镇痛 META分析 

分 类 号：R614[医药卫生—麻醉学]