部脊椎手术中的部水平区域脊神经阻塞:随机对照试验的系统审查和元分析
Bryan Gervais de Liyis1, I Gusti Agung Gede Utara Hartawan2, I Putu Eka Widyadharma3
1Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia.
World neurosurgery
|August 10, 2024
概括
区域副脊神经阻塞在椎脊柱手术后显著减少疼痛和阿片类药物使用. 像ESPB和ISPB这样的技术,特别是用更大的剂量和超声指导,提供了更好的结果.
科学领域:
- 麻醉学 麻醉学
- 神经外科 神经外科
- 疼痛管理 疼痛管理
背景情况:
- 区域副脊髓神经阻塞显示出在椎脊椎手术中控制疼痛和减少阿片类药物消耗的潜力.
- 评估特定的宫水平区域脊神经阻断技术的疗效对于优化术后护理至关重要.
研究的目的:
- 系统地评估区域脊神经阻断技术在减少部脊椎手术后的术后疼痛和阿片类药物利用方面的有效性.
主要方法:
- 在主要数据库 (ScienceDirect,PubMed,Embase,Cochrane) 进行了对随机对照试验 (RCT) 的系统审查,直到2024年3月.
- 关键的结果措施包括术后疼痛评分和阿片类药物消费.
- 评估了起器脊柱平面块 (ESPB),半脊柱间平面块 (ISPB) 和表面椎块 (CPB).
主要成果:
- 六项涉及648名参与者的RCT表明,区域副脊神经阻塞在多个时间点 (4,6,8,12,24小时) 显著降低了术后疼痛.
- 在阻断组中,阿片类药物利用率明显较低 (MD:-1.68),并发症显著减少 (OR:0.51).
- 特定的技术,如ESPB和ISPB,后部方法,双边管理和超声指导与显著的阿片类药物减少有关.
结论:
- 宫水平区域脊神经阻塞在缓解术后疼痛和减少宫脊椎手术后阿片类药物需求方面是有效的.
- 使用超过10毫升的剂量,使用ESPB或ISPB技术,以及使用后部,双边和超声导向方法观察到最佳结果.
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