局部麻醉与硬膜外麻醉用于经皮椎间孔镜腰椎间盘切除术的有效性和安全性的Meta分析

Meta-analysis of effectiveness and safety between local anesthesia vs epidural anesthesia for percutaneous transforaminal endoscopic discectomy

摘要:

目的 应用Meta分析综合评价局部麻醉（LA）与硬膜外麻醉（EA）用于经皮椎间孔镜腰椎间盘切除术（PTED）的有效性和安全性，以期为临床决策提供参考依据。方法 计算机检索PubMed、Embase、The Cochrane Library、Web of Science、Medline、Science Direct、中国知网、中国生物医学文献数据库和万方数据中从建库起至2022年3月，关于比较LA和EA用于PTED的随机对照试验（RCT）和回顾性研究，录入Review Manager 5.3软件进行Meta分析。结果 纳入14篇文献，共1 619例患者。Meta分析显示：EA组术中腰部疼痛视觉模拟评分（VAS）和术后并发症发生率明显低于LA组，麻醉满意率明显高于LA组，两组患者比较，差异均有统计学意义（P < 0.05），两组患者手术时间、腿部疼痛VAS和术后Oswestry功能障碍指数（ODI）比较，差异均无统计学意义（P > 0.05）。结论 在PTED中，EA与LA同样安全，且术中镇痛效果优于LA，可作为一种可靠的麻醉技术在临床推广应用。

Abstract:

Objective To compare the effectiveness and safety of local anesthesia (LA) and epidural anesthesia (EA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making.Methods We searched PubMed, Embase, the Cochrane Library, Web of Science, Medline, Science Direct, China National Knowledge Infrastructure，Chinese Biomedical Literature Database and Wanfang Database from inception to March 2022 in order to identify randomized and nonrandomized controlled trials comparing LA and EA for PTED. Meta-analysis was conducted using Review Manager 5.3 software.Results 14 studies involving a total of 1 619 patients were included. Meta-analysis revealed the visual analogue scale (VAS) of waist and complication rate of EA group were lower than those of LA group, and the anesthesia satisfaction rate was higher than that of LA group, the differences were statistically significant (P < 0.05). There were no significant differences of surgical duration, VAS of leg and postoperative Oswestry disability index (ODI) between the two groups (P > 0.05).Conclusion EA is as safe as LA and produces better anesthetic effects than those of LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.