我们的目的是比较胸神经阻滞(Pecs)I和II与对照或其他技术在乳腺癌手术中使用的安全性和有效性,如局部麻醉,椎旁阻滞,和竖脊肌平面块(ESPB)。
我们搜索了4个搜索引擎(PubMed,科克伦图书馆,Scopus,和WebofScience)进行相关试验,然后提取数据,并在随机效应模型下使用ReviewManagerSoftware进行组合。
我们发现了47项研究,其中37例纳入了我们的荟萃分析。关于术中阿片类药物的消耗,与对照相比,在PecsII中检测到显着降低(标准化平均差[SMD]=-1.75,95%置信区间[CI][-2.66,-0.85],P=0.0001)和PecsI合并锯齿肌平面阻滞(SMD=-0.90,95%CI[-1.37,-0.44],P=0.0002)。术后阿片类药物的消耗量在PecsⅡ组显著降低(SMD=-2.28,95%CI[-3.10,-1.46],P<0.00001)与对照相比,与PecsII与ESPB相比(SMD=-1.75,95%CI[-2.53,-0.98],P<0.00001)。此外,与单独使用PecsII相比,在PecsII中添加右美托咪定可显着降低术后阿片类药物的消耗量(SMD=-1.33,95%CI[-2.28,-0.38],P=0.006)。
在乳腺癌手术中,Pecs阻滞是一种安全有效的镇痛方法。它显示出比ESPB更低的内和术后阿片类药物消耗,与对照组相比,疼痛减轻,椎旁阻滞,和局部麻醉,与右美托咪定合用效果更好。
We aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB).
We searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using
Review Manager Software.
We found 47 studies, 37 of them were included in our meta-analysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD]=-1.75, 95% confidence interval [CI] [-2.66, -0.85], P=0.0001) and Pecs I combined with serratus plane block (SMD=-0.90, 95% CI [-1.37, -0.44], P=0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD=-2.28, 95% CI [-3.10, -1.46], P<0.00001) compared with control and Pecs II compared with ESPB (SMD=-1.75, 95% CI [-2.53, -0.98], P<0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD=-1.33, 95% CI [-2.28, -0.38], P=0.006).
Pecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.