双边竖脊肌平面阻滞降低腹腔镜胆囊切除术后阿片类药物消耗、疼痛评分和恶心呕吐的系统评价与Meta分析

A Systematic Review and Meta-analysis of Bilateral Erector Spinae Plane Block for Reducing Opioid Consumption,Pain Score and Nausea and Vomiting after Laparoscopic Cholecystectomy

目的:评价双边竖脊肌平面阻滞(erector spinae plane block,ESPB)在降低腹腔镜胆囊切除术后阿片类药物消耗、疼痛评分和恶心呕吐中的效果。方法:由2名独立研究员按照检索策略在中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed、Web of Science 、Embase及Cochrane Library中英文数据库中检索比较全身麻醉联合双边ESPB(ESPB组)和单纯全身麻醉非阻滞(对照组)用于腹腔镜胆囊切除术后镇痛的随机对照试验(randomized controlled trial,RCT)文献,检索时间为建库至2022年1月15日。观察结局指标包括术后阿片类镇痛药物的消耗量;术后各时间点的疼痛评分;术后恶心呕吐的发生率。采用RevMan 5.4和Stata 16.0两种软件进行Meta分析。结果:共纳入11篇RCT文献,共633例患者。双边ESPB能够显著降低腹腔镜胆囊切除术后24 h阿片类药物消耗量[MD=-6.73,95%CI(-8.39,-5.07),P<0.000 01]。双边ESPB显著降低腹腔镜胆囊切除术后24 h各时间点的疼痛评分,即术后清醒拔除气管导管后即刻静息疼痛评分[MD=-1.16,95%CI(-1.60,-0.71),P<0.000 01],术后清醒拔除气管导管后即刻运动疼痛评分[MD=-1.18,95%CI(-1.58,-0.77),P<0.000 01];术后20 min静息疼痛评分[MD=-1.52,95%CI(-1.82,-1.21),P<0.000 01],术后20 min运动疼痛评分[MD=-1.62,95%CI(-2.05,-1.19),P<0.000 01];术后40 min静息疼痛评分[MD=-1.38,95%CI(-1.60,-1.16),P<0.000 01],术后40 min运动疼痛评分[MD=-1.42,95%CI(-1.76,-1.09),P<0.000 01];术后1 h静息疼痛评分[MD=-0.67,95%CI(-1.02,-0.32),P=0.000 1],术后1 h运动疼痛评分[MD=-1.02,95%CI(-1.17,-0.87),P<0.000 01];术后2 h静息疼痛评分[MD=-0.38,95%CI(-0.52,-0.24),P<0.000 01],术后2 h运动疼痛评分[MD=-0.50,95%CI(-0.66,-0.34),P<0.000 01];术后3~4 h静息疼痛评分[MD=-0.98,95%CI(-1.69,-0.28),P=0.006],术后3~4 h运动疼痛评分[MD=-1.23,95%CI(-2.11,-0.35),P=0.006];术后6 h静息疼痛评分[MD=-0.91,95%CI(-1.30,-0.52),P<0.000 01],术后6 h运动疼痛评分[MD=-0.98,95%CI(-1.44,-0.53),P<0.000 1];术后12 h静息疼痛评分[MD=-0.66,95%CI(-1.05,-0.26),P=0.001],术后12 h运动疼痛评分[MD=-0.86,95%CI(-1.21,-0.50),P<0.000 01];术后24 h静息疼痛评分[MD=-0.36,95%CI(-0.59,-0.13),P=0.002],术后24 h运动疼痛评分[MD=-0.35,95%CI(-0.64,-0.07),P=0.02]。双边ESPB能够降低腹腔镜胆囊切除术后24 h恶心的发生率[RR=0.54,95%CI(0.34,0.87),P=0.01],降低术后24 h PONV的发生率[RR=0.22,95%CI(0.09,0.55),P=0.001]。结论:双边竖脊肌平面阻滞不仅能降低腹腔镜胆囊切除术后阿片类药物消耗和术后疼痛评分,还可降低其术后恶心的发生率。

Objective:To evaluate the effect of bilateral erector spinae plane block (ESPB) in reducing opioid consumption,pain score and nausea and vomiting after laparoscopic cholecystectomy.Method:According to the search strategy,randomized controlled trial (RCT) literatures of general anesthesia combined with bilateral ESPB (ESPB group) and simple general anesthesia non block for analgesia (control group) after laparoscopic cholecystectomy were searched and compared in Chinese biomedical literature database,CNKI,Wanfang database,VIP database,PubMed,Web of Science,Embase and Cochrane Library by two independent researchers.The retrieval time was from the establishment of the database to January 15,2022.Outcome measures included consumption of opioid analgesics after operation,pain score at each time point after operation,the incidence of postoperative nausea and vomiting.RevMan 5.4 and Stata 16.0 were used for meta-analysis.Result:A total of 633 patients were included in 11 RCT literatures.Bilateral ESPB significantly reduced opioid consumption at 24 hours after laparoscopic cholecystectomy[MD=-6.73,95%CI (-8.39,-5.07),P<0.000 01].Bilateral ESPB significantly reduced pain scores at all time points 24 h after laparoscopic cholecystectomy,resting pain score immediately following awake postoperative tracheal tube extubation[MD=-1.16,95%CI (-1.60,-0.71),P<0.000 01],motor pain score in the immediate postoperative period following awake tracheal tube extubation[MD=-1.18,95%CI (-1.58,-0.77),P<0.000 01];resting pain score at 20 minutes postoperatively[MD=-1.52,95%CI (-1.82,-1.21),P<0.000 01],motor pain score at 20 minutes postoperatively[MD=-1.62,95%CI (-2.05,-1.19),P<0.000 01];resting pain score at 40 min postoperatively[MD=-1.38,95%CI (-1.60,-1.16),P<0.000 01],motor pain score at 40 min postoperatively[MD=-1.42,95%CI (-1.76,-1.09),P<0.000 01];resting pain score at 1 h postoperatively[MD=-0.67,95%CI (-1.02,-0.32),P=0.000 1],motor pain score at 1 h postoperatively[MD=-1.02,95%CI (-1.17,-0.87),P<0.000 01];resting pain score at 2 h postoperatively[MD=-0.38,95%CI (-0.52,-0.24),P<0.000 01],motor pain score at 2 h postoperatively[MD=-0.50,95%CI (-0.66,-0.34),P<0.000 01];resting pain score at 3-4 hpostoperatively[MD=-0.98,95%CI (-1.69,-0.28),P=0.006],motor pain score at 3-4 h postoperatively[MD=-1.23,95%CI (-2.11,-0.35),P=0.006];resting pain scores at 6 h postoperatively[MD=-0.91,95%CI (-1.30,-0.52),P<0.000 01],motor pain scores at 6 h postoperatively[MD=-0.98,95%CI(-1.44,-0.53),P<0.000 1];resting pain scores at 12 h postoperatively[MD=-0.66,95%CI (-1.05,-0.26),P=0.001],motor pain score at 12 h postoperatively[MD=-0.86,95%CI (-1.21,-0.50),P<0.000 01];resting pain score at 24 h postoperatively[MD=-0.36,95%CI (-0.59,-0.13),P=0.002],motor pain score at 24 h postoperatively[MD=-0.35,95%CI (-0.64,-0.07),P=0.02].Bilateral ESPB reduced the incidence of nausea at 24 hours after laparoscopic cholecystectomy[RR=0.54,95%CI(0.34,0.87),P=0.01],reduced the incidence of PONV at 24 h after operation[RR=0.22,95%CI (0.09,0.55),P=0.001].Conclusion:Bilateral erector spinae plane block can not only reduce opioid consumption and postoperative pain score after laparoscopic cholecystectomy,but also reduce the incidence of postoperative nausea.