目的:超声引导下竖脊肌平面阻滞(ESPB)常用于成人围手术期镇痛;其在儿科患者中的镇痛效果和安全性仍不确定.本综述旨在确定超声引导下ESPB是否可以提高小儿手术的镇痛效果和安全性。
方法:随机对照试验的Meta分析。
方法:围手术期设置。
方法:全麻下择期手术的儿科患者。
方法:我们搜索了PubMed,Embase,Cochrane中央控制试验登记册,Cochrane系统评价数据库,KoreaMed,WebofScience,Scopus,和ClinicalTrials.gov数据库,用于符合条件的已发表随机对照研究(RCT),将ESPB与对照组(无阻滞或其他阻滞)在全麻下进行择期手术的儿科患者中进行比较。
方法:主要结果是术后累积阿片类药物消耗量。其他结果包括术中阿片类药物的消耗,第一次请求抢救镇痛的时间,需要抢救镇痛药的患者数量,和手术后的疼痛评分。安全性结果是心动过缓的发生率,低血压,术后呕吐。
结果:分析包括17项RCT,包括919名参与者:ESPB组461人,无阻断组(无阻断/假阻断)269,189在另一个街区组。与对照组(无阻滞和其他阻滞)相比,ESPB显着降低了术后的累积阿片类药物消耗量(静脉注射吗啡毫克当量)(标准化平均差=-1.51;95%置信区间,-2.39至-0.64;P=0.0002;I2=92.9%)和术中阿片类药物消耗量,并降低平均疼痛评分,直至手术后24小时。ESPB延长了首次要求抢救镇痛的时间,减少了需要抢救镇痛药的患者数量。此外,ESPB在手术后24h的大部分时间点降低了疼痛评分,提高了父母的满意度,与无阻滞/假阻滞相比,术后呕吐的发生率降低。
结论:ESPB为全麻下择期手术的儿科患者提供了有效和安全的围手术期镇痛。
OBJECTIVE: Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This
review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.
METHODS: Meta-analysis of randomized controlled trials.
METHODS: Perioperative setting.
METHODS: Pediatric patients undergoing elective surgery under general anesthesia.
METHODS: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and ClinicalTrials.gov databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.
METHODS: The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.
RESULTS: The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = -1.51; 95% confidence interval, -2.39 to -0.64; P = 0.0002; I2 = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.
CONCLUSIONS: ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.