跨鼻腔膜关节阻断用于腹腔穿刺后头痛管理:随机试验的元分析
Priyanka Dwivedi1, Pratibha Singh1, Tejas K Patel2
1All India Institute of Medical Sciences, Department of Anaesthesiology, Gorakhpur, India.
Brazilian journal of anesthesiology (Elsevier)
|July 8, 2023
概括
与保守护理和lignocaine相比,跨鼻的Sphenopalatine Ganglion (SPG) 阻断可以为PDPH提供短期的疼痛缓解. 有证据表明,SPG阻断在初始疼痛减轻方面是优越的,但对于长期结果或不良事件而言并非如此.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 神经学 神经学
背景情况:
- 穿刺后头痛 (PDPH) 是神经轴麻醉后的一个常见并发症.
- 目前PDPH的管理策略各不相同,具体干预措施的有效性证据有限.
研究的目的:
- 与其他PDPH治疗方法相比,评估跨鼻的Sphenopalatine Ganglion (SPG) 阻塞的疗效和安全性.
- 综合来自SPG块PDPH管理的随机对照试验 (RCT) 的证据.
主要方法:
- 对RCT进行系统的文献搜索,比较过鼻SPG阻断与控制干预 (保守性,鼻内联诺卡因,假冒,大尾神经[GON]阻断).
- 使用Mantle-Haenszel方法和随机效应模型的元分析.
- 使用GRADE方法评估的证据质量.
主要成果:
- 在30分钟,1小时,2小时和4小时的疼痛减轻和减少治疗失败 (非常低到中等的证据) 方面,SPG阻断显示优于保守治疗.
- 在30分钟,1小时,6小时和24小时的疼痛缓解方面,SPG阻断优于鼻内联诺卡因.
- 在所有结果中,与假冒或GON块相比,没有发现SPG块的优越性或等效性.
结论:
- 跨鼻腔SPG阻塞提供短期缓解PDPH的疼痛,与保守治疗和lignocaine吸气相比.
- 证据质量从非常低到中等,表明需要进一步进行高质量的研究.
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