超声引导下椎旁神经阻滞治疗带状疱疹相关疼痛的Meta分析

Ultrasound-guided paravertebral nerve block for zoster-associated pain: a Meta-analysis

背景:目前临床研究显示超声引导下椎旁神经阻滞治疗胸腰段带状疱疹相关疼痛有显著效果,并在临床上得到了广泛使用。目的:系统评价超声引导下椎旁神经阻滞治疗胸腰段带状疱疹相关疼痛的有效性及安全性,为临床治疗提供参考依据。方法:检索PubMed、The Cochrane Library、EMBASE、CNKI、WanFang Data、VIP以及CBM等数据库,检索时限为建库至2019-01-01。根据制定的纳入和排除标准,收集有关超声引导下椎旁神经阻滞治疗及药物治疗胸腰段带状疱疹急性期疼痛或带状疱疹后神经痛的随机对照试验,以超声引导下胸椎旁神经阻滞组作为实验组,药物治疗组或传统椎旁神经阻滞组作为对照组。依据Cochrane Handbook 5.1.0偏倚风险评估工具评价纳入文献质量。通过Revman 5.3软件对文献数据进行Meta分析。结果与结论:①最终纳入11项随机对照试验研究文献,共916例受试者;②Meta分析结果显示:与对照组相比,超声引导下椎旁神经阻滞组的镇痛效果更好,在1-4周内临床镇痛效果最佳,采用随机效应模型下分析,1周:MD=-0.91,95%CI(-1.22,-0.61),P<0.00001;2周:MD=-1.11,95%CI(-1.52,-0.70),P<0.00001;3周:MD=-1.26,95%CI(-1.79,-0.74),P<0.00001;4周:MD=-0.90,95%CI(-1.57,-0.24),P=0.007;同时睡眠质量及治疗有效率均有提高[固定效应模型下分析,OR=3.63,95%CI(2.38,5.53),P<0.00001],统计结果差异有显著性意义,并且具有未增加整个治疗过程的不良反应等优点;③结果说明,超声引导下椎旁神经阻滞治疗胸腰段带状疱疹相关疼痛是安全和有效的。

BACKGROUND:Current studies have shown that ultrasound-guided paravertebrospinal nerve block widely used has a significant effect in the clinical treatment of thoracolumbar zoster-associated pain.OBJECTIVE:To systematically evaluate the efficacy and safety of ultrasound-guided paravertebral nerve block in the treatment of thoracolumbar zoster-associated pain and to provide reference for clinical treatment.METHODS:We searched relevant literature in PubMed,The Cochrane Library,EMBASE,China National Knowledge Infrastructure(CNKI),WanFang Data,China Science and Technology Journal Database(VIP)and Chinese Biomedical Literature Database(CBM).The limit of searching time was from inception until January 1,2019.Randomized controlled trials addressing ultrasound-guided paravertebral nerve block(experimental group)versus drug therapy(control group)for the treatment of acute zoster-associated pain or postherpetic neuralgia were collected according to the criteria for inclusion and exclusion.Literature quality was assessed according to Cochrane Handbook 5.1.0 bias risk assessment tool.The literature data were analyzed using Revman 5.3 software through a Meta-analysis.RESULTS AND CONCLUSION:A total of 11 randomized controlled trials involving 916 patients met the inclusion criteria.The results of Meta-analysis showed that compared with the control group,the ultrasound-guided paravertebral nerve block group had better analgesic effect and the optimal analgesic effect appeared within 1-4 weeks.A random effects model was then used[1st week:mean difference(MD)=-0.91,95%confidence interval(CI)(-1.22,-0.61),P<0.00001;2nd week:MD=-1.11,95%CI(-1.52,-0.70),P<0.00001;3rd week:MD=-1.26,95%CI(-1.79,-0.74),P<0.00001;4th week:MD=-0.90,95%CI(-1.57,-0.24),P=0.007].At the same time,the quality of sleep and the effective rate of treatment were improved,and a fixed effects model was used[odds ratio=3.63,95%CI(2.38,5.53),P<0.00001].The statistical results showed significant difference.There was no increase in post-treatment adverse reactions.Therefore,ultrasound-guided paravertebral nerve block is safe and effective for the treatment of zoster-associated pain in the thoracolumbar region.