超声引导下腘窝坐骨神经阻滞鞘膜下与鞘外注射用于胫骨和足部手术临床效果的Meta分析

Comparison of Clinical Effects of Subparaneural and Extraparaneural Injection of Popliteal Sciatic Nerve Under Ultrasound Guidance:A Systematic Review and Meta-Analysis

目的评价超声引导下腘窝坐骨神经阻滞神经鞘膜下注射(IPS)与鞘外注射(OPS)在成人胫骨及足部手术的阻滞效果。方法检索Cochrane-Library、PubMed、EMBASE、中国知网、万方数据库、维普数据库,纳入腘窝坐骨神经阻滞鞘膜下注射与鞘外注射在成人胫骨及足部手术阻滞效果比较的随机对照试验,根据PRISMA准则采用RevMan 5.3软件进行Meta分析。主要结局指标为30 min内阻滞成功率,次要结局指标为阻滞操作时间、起效时间、阻滞持续时间、神经损伤相关并发症和神经内注射发生率。结果最终纳入9项RCTs,共499例患者。与OPS组相比,IPS组30 min内有更高的完全阻滞成功率[OR=4.98,95%CI(2.80,8.87),I 2=0%,P<0.05]。IPS组的操作时间[MD=-1.14,95%CI(-1.72,-0.56),I 2=12%,P<0.05],起效时间[MD=-8.95,95%CI(-10.28,-7.62),I 2=34%,P<0.05]均明显降低。IPS组持续感觉阻滞时间明显高于OPS组[MD=3.24,95%CI(1.44,5.05),I 2=79%,P<0.05]。两组神经损伤相关并发症和神经内注射的发生率无统计学差异[OR=0.89,95%CI(0.34,2.29),I 2=0%,P=0.80],[OR=0.54,95%CI(0.17,1.69),I 2=10%,P=0.29]。结论胫骨及足部手术中,腘窝坐骨神经阻滞鞘膜下注射阻滞成功率高于鞘外注射,且不良反应风险未增加。

Objective To evaluate the efficacy of ultrasound-guided Subparaneural(IPS)and extraparaneural injection(OPS)for popliteal sciatic nerve block in foot and tibia surgery.Methods Literatures were retrieved from databases including Cochrane Library,PubMed,EMBASE,CNKI,WanFang and VIP.We used RevMan 5.3 software to synthesis data according to the rule of Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA).Complete block in 30 min was primary outcome,while secondary outcomes were the produce time,onset time of complete sensory block,the duration of complete sensory block,the rate of postoperative adverse events and the incidence of intraneural injection.Results 9 RCTs involving 499 patients were included.Meta-analysis of these studies showed that compared with group OPS,the group IPS had the higher rate of Complete block in 30 min[OR=4.98,95%CI(2.80,8.87),I 2=0%,P<0.05],had shorter produce time[MD=-1.14,95%CI(-1.72,-0.56),I 2=12%,P<0.05];the onset time of complete sensory block[MD=-8.95,95%CI(-10.28,-7.62),I 2=34%,P<0.05],and had the longer duration of complete sensory block[MD=3.24,95%CI(1.44,5.05),I 2=79%,P<0.05].There was no significant difference between the rate of postoperative adverse event and the incidence of intraneural injection[OR=0.89,95%CI(0.34,2.29),I 2=0%,P=0.80],[OR=0.54,95%CI(0.17,1.69),I 2=10%,P=0.29].Conclusion In operation of tibia and foot below knee,the success rate of Subparaneura injection of popliteal sciatic nerve block could be higher than that of extraparaneural injection,and the risk of adverse reactions was not increased.