前锯肌平面神经阻滞对胸腔镜患者麻醉和镇痛效果的meta分析

Anesthetic and analgesic effect of serratus anterior plane nerve block in thoracoscopic patients:a meta analysis

目的分析超声引导下前锯肌平面神经阻滞(SPB)复合全身麻醉对胸腔镜手术患者的麻醉与镇痛效果。方法检索PubMed、EMBASE、Springer、Cochrane图书馆、中国生物医学文献数据库、中国知网、万方数据库及维普数据库。分析SPB复合全身麻醉(SPB组)与全身麻醉(GA组)用于胸腔镜手术后镇痛效果的随机对照试验(RCT),比较术后静息疼痛数字评分法(NRS)评分、术中阿片类药物用量、术后恶心呕吐、术后恢复质量量表(QoR-40)评分、术后苏醒时间。结果共获得12篇符合标准的RCTs(n=859)。meta分析结果显示,SPB组术后2 h[MD=-2.06,95%CI(-2.95,-1.17),P<0.01]、6 h[MD=-2.40,95%CI(-2.85,-1.95),P<0.01]、12 h[MD=-1.34,95%CI(-1.68,-1.00),P<0.01]、24 h[MD=-0.74,95%CI(-1.12,-0.36),P<0.01]NRS评分低于GA组,术中镇痛药物瑞芬太尼用量少于GA组[SMD=-1.82,95%CI(-3.37,-0.28),P<0.01],术后恶心呕吐的发生率更低[OR=-0.48,95%CI(0.29,0.78),P<0.01],术后12 h QoR-40评分更高[MD=20.55,95%CI(-3.46,44.56),P<0.01],苏醒时间更短[MD=-6.08,95%CI(-7.50,-4.66),P<0.01]。结论超声引导下SPB复合全身麻醉用于胸腔镜手术中,能明显降低术后静息NRS评分,减少术中瑞芬太尼用量,降低术后恶心呕吐的发生率,术后QoR-40评分更高,苏醒时间更快,患者恢复质量较好。

Objective To analyze the anesthetic and analgesic effects of serratus anterior plane nerve block(SPB)combined with general anesthesia(GA)under the ultrasound guide in the patients undergoing thoracoscopic surgery.Methods The PubMed,EMBASE,Springer,Cochrane library,Chinese biomedical literature database,China National Knowledge Internet,Wanfang database and Wip database were retrieved.The randomized controlled trials(RCTs)on the postoperative analgesic effect of SBP combined with GA(SPB group)and GA(GA group)in thoracoscopic surgery were analyzed.The postoperative resting pain numerical scale(NRS),intraoperative opioid use dose,postoperative nausea and vomiting(PONV),postoperative recovery quality scale(QoR-40)score and postoperative recovery time were compared between the two groups.Results Twelve RCTs meeting the standard were obtained,involving 859 patients(n=859).The meta analysis results showed that,the NRS score at postoperative 2 h[MD=-2.06,95%CI(-2.95,-1.17),P<0.01],6 h[MD=-2.40,95%CI(-2.85,-1.95),P<0.01],12 h[MD=-1.34,95%CI(-1.68,-1.00),P<0.01]and 24 h[MD=-0.74,95%CI(-1.12,-0.36),P<0.01]in the SPB group were lower than those in the GA group.The intraoperative analgesic drug remifentanil dose was less than that in the GA group[SMD=-1.82,95%CI(-3.37,-0.28),P<0.01],incidence rate of PONV was lower[OR=-0.48,95%CI(0.29,0.78),P<0.01],the QoR-40 score at postoperative 12 h was higher[MD=20.55,95%CI(-3.46,44.56),P<0.01],and the recovery time was significantly shorter[MD=-6.08,95%CI(-7.50,-4.66),P<0.01].Conclusion The ultrasound-guided SPB combined with general anesthesia in the thoracoscopic surgery can significantly reduce the postoperative resting NRS score,decrease intraoperative remifentanil dosage,and reduce the incidence rate of PONV,increase the postoperative QoR-40 score,the recovery time is fast and the quality of patients′recovery is good.