神经阻滞预防性镇痛对髋部骨折患者围术期镇痛影响的Meta分析

Effects of pre-emptive analgesia with nerve block on perioperative analgesia in patients with hip fracture:a meta-analysis

目的系统评价神经阻滞预防性镇痛对髋部骨折患者围术期镇痛效果及安全性的影响。方法检索Cochrane、Pubmed、Embase、万方、维普、中国知网,收集髋部骨折后使用神经阻滞对患者行创伤后早期疼痛管理的随机对照试验(RCT),检索时间为建库至2023年3月。根据Cochrane指导手册独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3软件进行Meta分析。结果共纳入13篇RCT,共计患者1241例,神经阻滞组603例,对照组638例。与对照组比较,神经阻滞(或给药)后24 h运动时VAS疼痛评分明显降低(MD=-2.16分,95%CI-4.04~-0.28分,P<0.05),恶心呕吐发生率明显降低(OR=0.33,95%CI 0.20~0.52,P<0.05)。两组补救镇痛率、神经阻滞(或给药)后30 min内HR和MAP差异无统计学意义。结论神经阻滞预防性镇痛可降低髋部骨折患者神经阻滞后VAS疼痛评分和恶心呕吐发生率,但对补救镇痛率、神经阻滞后30 min内HR和MAP无明显影响。

Objective To systematically evaluated the effects of pre-emptive analgesia with nerve block on the perioperative analgesic effect and safety in patients with hip fracture.Methods Cochrane,Pubmed,Embase,Wanfang,VIP and CNKI were searched to collect the randomized controlled trial(RCT)of early post-traumatic pain management for patients receiving nerve block after the diagnosis of hip fracture.The search time was from the establishment of the database to March 2023.After independently selecting literature,extracting data,and evaluating the bias risk of inclusion in the study according to the Cochrane guidance manual,a meta-analysis was conducted using RevMan 5.3 software.Results A total of 13 RCTs were included,with a total of 1241 patients,603 patients in the never block group and 638 patients in the control group.Compared with the control group,the VAS pain score of 24 hours after nerve block(or using drugs)at exercising were significantly reduced(MD=-2.16,95%CI-4.04 to-0.28,P<0.05),the incidence of nausea and vomiting was significantly reduced(OR=0.33,95%CI 0.20 to 0.52,P<0.05)in the never block group.There were no significant differences in remedial analgesia rate,30 minutes after nerve block(or using drugs)of HR and MAP between the two groups.Conclusion Pre-emptive analgesia of nerve block can reduce the VAS pain score and the incidence of nausea or vomiting in patients with hip fracture,however,there is no significant effect on remedial analgesia rate,30 minutes after nerve block of heart rate and mean arterial pressure.