前锯肌平面阻滞与胸椎旁阻滞用于胸外科手术患者术后镇痛效果的Meta分析

Postoperative analgesia effect of serratus anterior plane block and thoracic paravertebral block in patients undergoing thoracic surgery： a meta-analysis

中文关键词: 前锯肌平面阻滞  胸椎旁阻滞  胸外科手术  术后镇痛  Meta分析

英文关键词: Serratus anterior plane block  Thoracic paravertebral block  Thoracic surgery  Postoperative analgesia  Meta-analysis

中文摘要:

      
目的 比较超声引导下前锯肌平面阻滞（SAPB）与胸椎旁阻滞（TPVB）对胸外科手术患者术后镇痛的效果。
方法 检索Cochrane、Pubmed、Embase、Web of Science、中国知网、维普、万方和中国生物医学全文数据库，纳入SAPB与TPVB在成人胸外科手术后镇痛比较的随机对照试验（RCT）。按照Cochrane指导手册选择文献、提取资料及评价研究质量。采用RevMan 5.4进行Meta分析。
结果 共纳入8篇RCTs，共计434例患者，其中SAPB组217例，TPVB组217例。两组术后1、2、4、6、12、24、48 h的静息及活动时VAS疼痛评分差异无统计学意义。SAPB组术后48 h内阿片类药物用量明显低于TPVB组（MD=-9.34 μg， 95%CI -17.1～-1.58 μg， P=0.02），低血压发生率明显低于TPVB组（RR=0.23，95%CI 0.07～0.76， P=0.02）。
结论 超声引导下SAPB与TPVB对胸外科手术患者术后镇痛效果相当，但采用SAPB患者术后阿片类药物用量明显减少、低血压发生率明显降低。

英文摘要:

      
Objective To compare the analgesic effect of serratus anterior plane block (SAPB) and thoracic paraverbral block (TPVB) guided under ultrasound in patients undergoing thoracic surgery.
Methods Cochrane, Pubmed, Embase, Web of Science, CNKI, VIP database, Wanfang database and China biomedical full-text database were searched for randomized controlled trials (RCTs) comparing SAPB and TPVB in postoperative analgesia after thoracic surgery in adults. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.4.
Results Eight RCTs with a total of 434 patients were finally included, including 217 patients in the SAPB group and 217 patients in the TPVB group. There were no statistically significant differences in VAS pain scores between the two groups at 1, 2, 4, 6, 12, 24, and 48 hours postoperatively in the resting and activity states. Compared with TPVB group, the dosage of opioids in SAPB group was significantly lower than that in TPVB group within 48 hours after operation (MD = -9.34 μg,95% CI -17.1 to -1.58 μg, P = 0.02), and the incidence of hypotension was significantly lower in SAPB group than that in TPVB group(RR = 0.23, 95% CI 0.07 to 0.76, P = 0.02).
Conclusion Ultrasound-guided SAPB are comparable to TPVB for postoperative analgesia in thoracic surgery, but the total opioid dosage is less and the incidence of hypotension is lower after SAPB.