勃起器脊柱平面块对痛的疗效:一个系统性审查和元分析
Bart Gerard Jan Candel1,2, Laura N Visser3, Ewoud Ter Avest4,5
1Emergency Department, Máxima Medical Centre, Veldhoven, The Netherlands b.candel@mmc.nl.
Emergency medicine journal : EMJ
|October 18, 2024
概括
勃起器脊柱平面阻塞 (ESPB) 在急诊室 (ED) 显示,对痛的疼痛减少具有统计学意义. 然而,这些证据的确定性非常低,需要进一步进行高质量的试验.
科学领域:
- 紧急医疗 紧急医疗
- 疼痛管理 疼痛管理
- 区域麻醉 区域麻醉
背景情况:
- 结,由结石引起的,呈现出严重的腹痛.
- 像NSAIDs和阿片类药物这样的标准治疗方法往往不能充分缓解疼痛.
- 勃起器脊柱平面阻塞 (ESPB) 是痛疼痛管理的新兴替代方案.
研究的目的:
- 系统地审查和元分析ESPB在急诊室 (ED) 治疗结肠的疗效和安全性.
主要方法:
- 随机对照试验 (RCT) 和病例系列的系统审查和元分析.
- 搜索了PubMed,EMBASE,科学网络和临床试验.gov直到2024年6月10日.
- 使用Cochrane风险偏差-2工具评估偏差风险和使用GRADE的证据确定性.
主要成果:
- 包括四项研究 (2项RCT,2项病例系列),涉及53名接受ESPB治疗的患者和40名接受标准护理的患者.
- 分析表明,ESPB使用30分钟和60分钟后,疼痛显著减少 (SMD分别为-1.41和-1.94).
- 证据确定性被降级为非常低,原因是偏差的高风险,实质性的异质性 (I2=85%) 和不准确性.
结论:
- 在ED中,ESPB证明了结肠的统计学上显著的疼痛减轻.
- 目前支持ESPB对结肠的证据的确定性非常低.
- 重点关注患者报告结果的高质量的RCT是必要的,以确认ESPB的有效性.
相关概念视频
Classification of Skeletal Muscle Relaxants
2.4K
Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
2.4K
Local Anesthetics: Clinical Application as Spinal Anesthesia
585
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
585
Skeletal Muscle Relaxants: Therapeutic Uses
468
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
468
Skeletal Muscle Relaxants: Adverse Effects
338
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
338
Depolarizing Blockers: Pharmocokinetics
311
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
311
Depolarizing Blockers: Mechanism of Action
1.5K
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
1.5K


