在接受腹部手术的患者中,双边勃起器脊柱平面块与双边横向腹部平面块:系统性审查和元分析
Matthew Stewart1, Tito D Tubog2, William Johnson3
1is Vice President of Anesthesia Services, Lifelinc Anesthesia, Memphis, Tennessee; and Faculty at Middle Tennessee School of Anesthesia, Madison, Tennessee.
勃起脊柱平面 (ESP) 块在腹部手术后提供了比横向腹部平面 (TAP) 块更好的急性疼痛管理. 阻断ESP减少了疼痛强度和阿片类药物使用,尽管临床益处很小.
科学领域:
- 麻醉学和疼痛管理
- 手术恢复优化手术恢复的优化
- 区域麻醉技术 区域麻醉技术
背景情况:
- 腹部手术后的术后疼痛显著影响患者的康复和生活质量.
- 区域麻醉,包括横腹平面 (TAP) 阻断和勃起器脊柱平面 (ESP) 阻断,用于减轻这种疼痛.
- 对术后疼痛ESP阻断与TAP阻断的比较疗效仍然是活跃研究的领域.
研究的目的:
- 为了比较勃起器脊柱平面 (ESP) 块与横腹平面 (TAP) 块在术后疼痛管理中的有效性.
- 评估ESP阻断对疼痛强度,阿片类药物消耗和恢复指标的影响,与TAP阻断相比.
- 评估ESP和TAP块之间的差异的安全性和临床相关性.
主要方法:
- 进行了随机对照试验的系统审查和元分析.
- 在PubMed,CINAHL,谷歌学者,科克兰图书馆和灰色文学中进行了搜索.
- 来自16项涉及934名患者的研究的数据使用平均差异和风险比率进行了分析,通过偏差风险和GRADE评估质量.
主要成果:
- 与TAP阻断相比,ESP阻断在前24小时内显示了静止和动态疼痛强度的统计显著降低.
- 阻断ESP还导致术后阿片类药物消费显著降低,并延长了第一次止痛救援的时间.
- 在ESP和TAP块之间没有观察到关于手术期间阿片类药物消费或恶心和吐的发生率的显著差异.
结论:
- 勃起器脊柱平面块在腹部手术后的急性术后疼痛管理方面,在统计学上表现优于横向腹部平面块.
- 虽然ESP阻断在减轻疼痛和减轻阿片类药物的效果方面有好处,但这些改善的临床意义被发现很小.
- 可能需要进一步的研究,以充分阐明ESP阻断在不同手术环境中的临床相关性和最佳应用.
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