浅层与深层前锯肌阻滞用于乳腺及胸部手术镇痛的Meta分析

Meta-analysis of Safety and Efficacy of Superficial and Deep Serratus Anterior Plane Block for Breast and Thoracic Surgery Analgesia

目的:系统评价超声引导下浅层前锯肌阻滞(SSAPB)与深层前锯肌阻滞(DSAPB)用于乳腺及胸部手术镇痛的安全性和有效性。方法:采用计算机检索英文数据库PubMed、Embase、Cochrane和Web of science,中文数据库中国知网、万方、维普和中国生物医学数据库,收集建库至2022年4月12日发表的关于浅层前锯肌阻滞(S组)与深层前锯肌阻滞(D组)用于乳腺及胸部手术镇痛比较的随机对照试验。采用Revman 5.4软件对符合纳入标准的文献进行Meta分析。结果:最终纳入7项随机对照实验(RCT)研究,共计410例患者;Meta分析结果显示,S组与D组术后1、6、12、24 h静息疼痛评分和12、24 h活动疼痛评分差异无统计学意义;2篇文献认为S组与D组在术后1 h和6 h活动疼痛评分略有差异,但差异均无统计学意义;2组术后补救性镇痛率及不良反应发生率差异无统计学意义。结论:浅层与深层前锯肌阻滞均能为乳腺和胸部手术提供满意的镇痛条件,两者镇痛效果和不良反应无明显差别。

Objective:To systematically evaluate the safety and efficacy of ultrasound-guided superficial serratus anterior plane block and deep serratus anterior plane block for analgesia in breast and thoracic surgery.Methods:PubMed,Embase,Cochrane,Web of Science,CNKI,Wanfang,VIP,and Chinese biomedical databases were retrieved from the establishment of the database to April 12,2022.Randomized controlled trials about superficial anterior serratus block(S group)and deep anterior serratus block(D group)for breast and thoracic surgery analgesia were collected.The Cochrane Handbook was used for reference retrieval,data extraction,and quality evaluation.Meta-analysis was performed using Revman 5.4 software.Results:Seven RCT studies were finally included,involving 410 patients.The results of the meta-analysis showed that there was no significant difference in the resting pain scores at 1,6,12 and 24 h after operation and the activity pain scores at 12 and 24 h after operation between group S and group D.The two studies suggested that there was a slight difference in the activity pain scores at 1 and 6 h after the operation between group S and group D,but the difference was not statistically significant.There was no significant difference in postoperative remedial analgesia rate and incidence of adverse reactions between the two groups.Conclusion:Superficial and deep anterior serratus block can provide satisfactory analgesic conditions for breast and chest surgery,and there is no significant difference in analgesic effect and adverse reactions between the two groups.