背景：肌间沟臂丛神经阻滞（ISB）是肩关节镜手术患者术后镇痛的常用神经阻滞技术；然而，它与潜在的严重并发症有关。肩胛骨上神经阻滞（SSNB）的使用已被描述为肩关节镜检查的一种替代策略，报道的副作用较少。本文旨在比较SSNB和ISB在肩关节镜手术中的影响。
方法：进行了一项荟萃分析，以确定肩关节镜手术中涉及SSNB和ISB的相关随机对照试验。WebofScience,PubMed,Embase,Cochrane控制试验登记册,科克伦图书馆,Highwire,CNKI,和万方数据库从2010年到2021年3月进行了搜索。
结果：我们在17项随机对照试验中确定了1255名患者。与ISB组相比，SSNB组PACU静息时VAS较高(P=0.003),术后1h(P=0.005),相似疼痛评分2h（P=0.39），3-4小时（P=0.32），术后6～8h(P=0.05),然后在手术后12小时降低VAS（P=0.00006），术后1天(P=0.62)和术后2天(P=0.70)再次VAS相似。至于带运动的VAS，SSNB组PACU疼痛评分较高(P=0.03),术后4-6小时VAS相似(P=0.25)，术后8-12h疼痛评分较低（P=0.01），术后1天VAS与ISB组相似（P=0.3）。24h时口服吗啡当量无显著差异(P=0.35),PACU停留时间（P=0.65），患者满意度(P=0.14)和呕吐率(P=0.56),局部压痛(P=0.87)。然而,SSNB组有较低的阻塞相关并发症，如Horner综合征（P<0.0001），麻木（P=0.002），呼吸困难（P=0.04），声音嘶哑(P=0.04)。
结论：我们的高水平证据证实SSNB是一种有效和安全的镇痛技术，是一种具有类似疼痛控制优势的临床上有吸引力的替代方法，吗啡的使用,关节镜肩关节手术中神经阻滞相关并发症较少，尤其是严重的慢性阻塞性肺疾病，阻塞性睡眠呼吸暂停,和病态肥胖。鉴于我们的荟萃分析的相关可能的偏见，我们需要更充分的动力和更好设计的RCT研究以及长期随访才能得出更明确的结论.
BACKGROUND: The
interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ISB during shoulder arthroscopy surgery.
METHODS: A meta-analysis was conducted to identify relevant randomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through March 2021.
RESULTS: We identified 1255 patients assessed in 17 randomized controlled trials. Compared with the ISB group, the SSNB group had higher VAS at rest in PACU (P = 0.003), 1 h after operation (P = 0.005), similar pain score 2 h (P = 0.39), 3-4 h (P = 0.32), 6-8 h after operation (P = 0.05), then lower VAS 12 h after operation (P = 0.00006), and again similar VAS 1 day (P = 0.62) and 2 days after operation (P = 0.70). As for the VAS with movement, the SSNB group had higher pain score in PACU (P = 0.03), similar VAS 4-6 h after operation (P = 0.25), then lower pain score 8-12 h after operation (P = 0.01) and again similar VAS 1 day after operation (P = 0.3) compared with the ISB group. No significant difference was found for oral morphine equivalents use at 24 h (P = 0.35), duration of PACU stay (P = 0.65), the rate of patient satisfaction (P = 0.14) as well as the rate of vomiting (P = 0.56), and local tenderness (P = 0.87). However, the SSNB group had lower rate of block-related complications such as Horner syndrome (P < 0.0001), numb (P = 0.002), dyspnea (P = 0.04), and hoarseness (P = 0.04).
CONCLUSIONS: Our high-level evidence established SSNB as an effective and safe analgesic technique and a clinically attractive alternative to
interscalene block with the SSNB\'S advantage of similar pain control, morphine use, and less nerve block-related complications during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis\'s relevant possible biases, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.
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