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全肩关节整形术的最佳止痛方案:一个随机对照试验和网络元分析

Shiye Li¹, Wenjie Chen², Liang'en Feng³

¹Pain Department of Hezhou People's Hospital, Hezhou, China.

Journal of orthopaedic surgery and research

|January 12, 2024

概括

单次射击间块 (ssISB) 在肩膀手术后提供了优质的早期疼痛控制. 连续间阻断 (cISB) 减少了吗啡的使用和住院,而局部透止痛 (LIA) 最好将总吗啡消耗量最小化.

科学领域:

整形外科手术整形外科手术
疼痛管理疼痛管理
麻醉学麻醉学

背景情况:

全肩关节整形术 (TSA) 疼痛管理涉及多种策略.
目前的证据比较脂质体布皮瓦卡因 (LB),局部透止痛 (LIA),单次射击间层阻断 (ssISB) 和连续间层阻断 (cISB) 是零碎的.
确定TSA的最佳止痛方法仍然是一个临床挑战.

研究的目的:

进行一个网络元分析,比较TSA的四种关键止痛方法.
根据疼痛评分,阿片类药物消耗和住院时间来确定最有效的止痛策略.
为TSA患者的手术后疼痛管理提供基于证据的建议.

主要方法:

在主要数据库 (PubMed,Embase等) 的系统文献搜索. 在2023年11月之前.
包括12项随机对照试验,涉及1537名接受TSA治疗的患者.
使用STATA 15.1进行的网络元分析与偏差风险评估.

主要成果:

单次射击间块 (ssISB) 在麻醉后护理单元 (PACU) 和早期术后几天 (VAS分数) 中显示出最有效的疼痛减轻效果.
连续间阻断 (cISB) 导致吗啡消费量减少最多,住院时间最短.
局部透镇痛 (LIA) 在术后的全部吗啡消耗方面表现最好,但疼痛控制较弱.

结论:

ssISB是最佳的立即术后疼痛控制 (PACU和早期).
cISB有效地减少了阿片类药物需求,并缩短了住院时间.
利亚在最大限度地减少整体吗啡使用方面表现出色,尽管对急性疼痛效果较差;LB显示效果有限.
结果指导了根据康复阶段和患者目标选择适当的止痛技术.

关键词:

连续的间层块连续的间层块.脂质体中的布皮瓦卡因.局部透镇痛局部透镇痛网络元分析网络元分析一次性射击的跨层层块.肩膀整体置换肩膀的整体置换

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