背景:肩胛骨上神经阻滞(SSNB)通过注射(SSNBi)和/或脉冲射频(PRF)为治疗疼痛的肩部病理提供了选择。描述了用于递送SSNB的多种技术,但是没有关于最佳症状控制的共识。本系统综述和荟萃分析旨在评估SSNB患者的结局,并探讨这种治疗方式的技术应用变化的影响。
方法:MEDLINE,Embase和CINAHL被搜索病例系列,从数据库开始到2021年1月28日发表的队列研究和随机对照试验.包括报道使用SSNBi或PRF治疗肩痛并至少随访3个月的文章。提取患者报告的结果指标(PROM),并汇总标准化平均差(SMD),按研究规模加权,已报告。使用Wylde的非总结性四点系统评估方法质量。
结果:在758篇参考文献中,包括18项研究,总计704SSNB。3个月时平均疼痛改善52.3%,荟萃分析显示SMD为2.37。尽管SSNBi与PRF联合显示2.75的最大SMD,但与用作单一疗法的SSNBi或PRF没有显着差异。治疗的位置和使用的指导技术不会影响结果。
结论:SSNBi和PRF为肩痛提供安全有效的治疗,根据PROMs的判断。这可能对Covid-19大流行期间的老年或合并症患者以及手术限制患者特别有价值。不管技术如何,患者的疼痛明显改善,持续超过3个月.
BACKGROUND: Suprascapular nerve blockade (SSNB) through injection (SSNBi) and/or pulsed radiofrequency (PRF) provide options for the management of painful shoulder pathology. Multiple techniques for delivery of SSNB are described but no consensus on optimal symptom control is available. This systematic
review and meta-analysis aims to assess patient-focussed outcomes in SSNB and explore the impact of variation in the technical application of this treatment modality.
METHODS: MEDLINE, Embase and CINAHL were searched for case series, cohort studies and randomised control trials published from database inception until 28 January 2021. Articles reporting use of SSNBi or PRF for treatment of shoulder pain with a minimum 3 months follow-up were included. Patient-reported outcome measures (PROMs) were extracted and the pooled standardised mean difference (SMD), weighted by study size, was reported. Quality of methodology was assessed using Wylde\'s nonsummative four-point system.
RESULTS: Of 758 references, 18 studies were included, totalling 704 SSNB. Average pain improvement at 3 months was 52.3%, with meta-analysis demonstrating a SMD of 2.37. Whereas SSNBi combined with PRF shows the greatest SMD of 2.75, this did not differ significantly from SSNBi or PRF when used as monotherapy. Location of treatment and the guidance technique used did not influence outcome.
CONCLUSIONS: SSNBi and PRF provide safe and effective treatment for shoulder pain, as judged by PROMs. This may be of particular value in aging or comorbid patients and with surgical restrictions during the COVID-19 pandemic. Regardless of technique, patients experience a marked improvement in pain that is maintained beyond 3 months.