髂筋膜腔隙阻滞用于股骨骨折患者椎管内麻醉摆放体位时镇痛效果的Meta分析

The analgesic efficacy of fascia iliaca compartment block during positioning before intrathecal anesthesia in patients with femur fracture: A Meta-analysis

目的系统评价髂筋膜腔隙阻滞(fascia iliaca compartment block,FICB)与阿片类镇痛药用于股骨骨折患者椎管内麻醉摆放体位时镇痛的有效性和安全性。方法计算机检索PubMed、Cochrane Library(2017年9月)、Embase、万方数据、中国知网、维普网和中国生物医学文献数据库,搜集关于FICB和阿片类镇痛药用于减轻股骨骨折患者行椎管内麻醉摆放体位时疼痛的随机对照试验(randomized controlled trial, RCT),检索时限均从建库至2017年10月。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入8个RCT,包括431例患者。Meta分析结果显示:与使用阿片类镇痛药缓解椎管内麻醉前体位摆放痛相比,FICB能有效降低股骨骨折患者椎管内麻醉前体位摆放时的疼痛评分[标准化均数差(standardized mean difference,SMD)=-2.37,95%CI(-2.89,-1.86),P<0.01],同时缩短椎管内麻醉的操作时间[SMD=-1.13,95%CI(-1.39,-0.88),P<0.01],且与FICB相关的并发症发生率亦较低[相对危险度(relative risk,RR)=0.10,95%CI(0.02,0.39),P<0.01]。结论与静脉使用阿片类镇痛药相比,FICB能够有效减轻股骨骨折患者椎管内麻醉前体位摆放引起的疼痛,同时并发症较少,且可以缩短椎管内麻醉操作时间。

Objective To systematically review the analgesic efficacy of fascia iliaca compartment block(FICB) during positioning before intrathecal anesthesia in patients with femur fractures. Methods Databases including PubMed, Cochrane Library (Issue9, 2017), Embase, Wanfang Database, CNKI, VIP and SinoMed were searched to collect randomized controlled trial (RCT) about FICB versus opioid analgesics for pain control during changes of position in patients with femur fracture from inception to October 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then Meta-analysis was performed using RevMan 5.3 software. Results A total of 8 RCT studies involving 431 patients were included. The results of Meta-analysis showed that, compared with opioid analgesics, FICB could shorten the pain score during positioning before intrathecal anesthesia[standardized mean difference(SMD)=-2.37, 95%CI(-2.89,-1.86), P<0.01], the time to perform intrathecal anesthesia [SMD=-1.13, 95%CI(-1.39,-0.88), P<0.01], and the incidence of FICB complications were significantly lower than opioid analgesics[relative risk(RR)=0.10, 95%CI(0.02, 0.39), P<0.01]. Conclusions Compared with opioid analgesics, FICB can relieve the pain during positioning before intrathecal anesthesia and shorten the time to perform intrathecal anesthesia, with less complications.