竖脊肌平面阻滞与胸椎旁神经阻滞用于成人胸腔镜肺叶切除术后镇痛效果的Meta分析

Meta-analysis of the analgesic effect of erector spine plane block versus thoracic paravertebral nerve block on adults after thoracoscopic lobectomy

摘要:

目的 评价超声引导下竖脊肌平面阻滞（ESPB）与胸椎旁神经阻滞（TPVB）用于成人胸腔镜肺叶切除术后的镇痛效果。方法 检索Embase、PubMed、Cochrane Library、中国知网、万方数据和维普网建库起至2022年1月的文献。纳入ESPB与TPVB用于成人胸腔镜肺叶切除手术的随机对照试验（RCT），用RevMan 5.3软件分析比较两组主要结局指标［术后6、12、24和48 h的视觉模拟评分（VAS）］及次要结局指标（神经阻滞操作时间、术后不良反应发生率、术后24 h补救镇痛率和术后镇痛泵按压次数）。结果 共纳入16个RCT，951例患者。Meta分析结果：ESPB组与TPVB组的术后6 h（MD_静息 = 0.04，95%CI：-0.15～0.22；MD_运动 = 0.10，95%CI：-0.07～0.28）、12 h（MD_静息 = 0.36，95%CI：-0.01～0.73；MD_运动 = 0.34，95%CI：-0.10～0.78）、24 h（MD_静息 = 0.26，95%CI：-0.44～0.96；MD_运动 = 0.52，95%CI：-0.40～1.43）和48 h（MD_静息 = 0.05，95%CI：-0.20～0.31；MD_运动 = 0.11，95%CI：-0.19～0.40）静息及运动VAS、术后24 h补救镇痛率（OR＾ = 1.37，95%CI：0.52～3.63）、术后恶心呕吐（OR＾ = 1.25，95%CI：0.82～1.89）、皮肤瘙痒（OR＾ = 0.86，95%CI：0.39～1.86）、胸闷发生率（OR＾ = 0.59，95%CI：0.07～4.63）和镇痛泵按压次数（MD = -0.10，95%CI：-0.28～0.08）比较，差异均无统计学意义（P > 0.05）；与TPVB组比较，ESPB组完成神经阻滞操作时间（MD = -2.40，95%CI：-3.25～-1.55）更短，术后低血压发生率（OR＾ = 0.29，95%CI：0.13～0.66）更低。结论 ESPB能提供与TPVB相似的术后镇痛效果，但其操作简单易学，且术后低血压发生率更低。故ESPB可作为成人胸腔镜肺叶切除手术后镇痛的一种新选择。

Abstract:

Objective To evaluate the postoperative analgesia effect of ultrasound-guided erector spine plane block (ESPB) versus thoracic paravertebral nerve block (TPVB) for thoracoscopic lobectomy in adults.Methods Database including PubMed, Embase, Cochrane-Library, CNKI, WanFang and VIP databases were searched from the beginning to January 2022. Collect RCT about postoperative analgesic efficacy of ESPB versus TPVB for adult thoracoscopic lobectomy. RevMan 5.3 software was used to analysis primary outcomes [visual analogue scale (VAS) at 6, 12, 24 and 48h after surgery) and secondary outcomes (the time of perform nerve block procedure, incidence of postoperative adverse events, remedial analgesia rate at 24 h postoperatively, and number of postoperative analgesic pump presses).Results 16 RCT with 951 patients were included. The results of Meta-analysis showed that: there were no statistically significant differences between the ESPB group and the TPVB group in the rest and exercise VAS at 6 h (MD rest = 0.04, 95%CI: -0.15~0.22; MD exercise = 0.10, 95%CI: -0.07~0.28), 12 h (MD rest = 0.36, 95%CI: -0.01 ~ 0.73; MD exercise = 0.34, 95%CI: -0.10~0.78), 24 h (MD rest = 0.26, 95%CI: -0.44 ~ 0.96; MD exercise = 0.52, 95%CI: -0.40 ~ 1.43), 48 h (MD rest = 0.05，95%CI：-0.20～0.31；MD exercise = 0.11，95%CI: -0.19 ~ 0.40) after surgery, the remedial analgesia rate at 24 h after surgery (OR＾ = 1.37, 95%CI: 0.52~3.63), the incidence of postoperative nausea and vomiting (OR＾ = 1.25, 95%CI: 0.82 ~ 1.89), skin itching (OR＾ = 0.86, 95%CI: 0.39 ~ 1.86), chest tightness (OR＾ = 0.59, 95%CI: 0.07 ~ 4.63), and the number of analgesia pump presses (MD = -0.10, 95%CI: -0.28 ~ 0.08). Compared with the TPVB group, the time to complete nerve block operation (MD = -2.40, 95%CI: -3.25 ~ -1.55) was shorter, and the incidence of postoperative hypotension (OR＾ = 0.29, 95%CI: 0.13 ~ 0.66) was lower in the ESPB group.Conclusion Ultrasound-guided ESPB provides identical effective analgesia with TPVB, however, ESPB is easier to operate and has a lower incidence of postoperative hypotension, so recommend the use of ESPB as an alternative to perioperative analgesic for adult thoracoscopic lobectomy.