目的:接受心脏手术的儿科患者通常会经历明显的手术疼痛。此外,不良的手术镇痛效果会产生持续到术后的疼痛。经胸肌平面阻滞(TTMPB)是一种新颖的平面阻滞技术,可以为前胸壁提供镇痛作用。TTMPB在小儿心脏手术中的镇痛作用尚不确定。进行荟萃分析以确定该程序的镇痛效果。
方法:系统评价和荟萃分析。PubMed,Embase,WebofScience,中部,万方数据,和中国国家知识基础设施搜索到2023年11月,以及建议评估分级,发展,并采用评价方法对证据的确定性进行评价。
方法:符合条件的研究纳入了计划接受心脏手术的2个月至12岁的儿科患者,并随机分配他们接受TTMPB或无阻断/假阻断。
结果:纳入了纳入601名儿科患者的6项研究。来自随机试验的低确定性证据表明,与无阻滞或假阻滞相比,在接受心脏手术的儿科患者中,TTMPB可能会降低12小时(加权平均差[WMD]-2.20,95%CI-2.73至-1.68)和24小时(WMD-1.76,95%CI-2.09至-1.42)的术后修正客观疼痛评分,术中阿片类药物消耗(WMD-3.83,95%CI-5.90至-1.76μg/kg),术后阿片类药物消耗(WMD-2.51,95%CI-2.84至-2.18μg/kg),重症监护病房(ICU)住院时间(WMD-5.56,95%CI-8.30至-2.83小时),拔管时间(WMD-2.13,95%CI-4.21至-0.05小时)。回顾性研究提供了非常低的确定性,即结果与随机试验一致。
结论:非常低的确定性证据表明,在接受心脏手术的儿科患者中,TTMPB可以减轻术后疼痛,阿片类药物的消费,ICU住院时间,和拔管时间。
OBJECTIVE: Pediatric patients undergoing cardiac surgery usually experience significant surgical pain. Additionally, the effect of poor surgical analgesia creates a pain continuum that extends to the postoperative period. Transversus thoracic muscle plane block (TTMPB) is a novel plane block technique that can provide analgesia to the anterior chest wall. The analgesic role of TTMPB in pediatric cardiac surgery is still uncertain. A meta-analysis was conducted to determine the analgesic efficacy of this procedure.
METHODS: Systematic review and meta-analysis. PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure were searched to November 2023, and the Grading of Recommendations Assessment, Development, and Evaluation approach was followed to evaluate the certainty of evidence.
METHODS: Eligible studies enrolled pediatric patients from 2 months to 12 years old scheduled to undergo cardiac surgery, and randomized them to receive a TTMPB or no block/sham block.
RESULTS: Six studies that enrolled 601 pediatric patients were included. Low-certainty evidence from randomized trials showed that, compared with no block or sham block, TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative modified objective pain score at 12 hours (weighted mean difference [WMD] -2.20, 95% CI -2.73 to -1.68) and 24 hours (WMD -1.76, 95% CI -2.09 to -1.42), intraoperative opioid consumption (WMD -3.83, 95% CI -5.90 to -1.76 μg/kg), postoperative opioid consumption (WMD -2.51, 95% CI -2.84 to -2.18 μg/kg), length of intensive care unit (ICU) stay (WMD -5.56, 95% CI -8.30 to -2.83 hours), and extubation time (WMD -2.13, 95% CI -4.21 to -0.05 hours). Retrospective studies provided very low certainty that the results were consistent with the randomized trials.
CONCLUSIONS: Very low- to low-certainty evidence showed that TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative pain, opioid consumption, ICU length of stay, and extubation time.