胸部手术后的区域性止痛技术:系统性审查和网络元分析
Meijuan Yang1, Xiaomei Zhang1, Gang Liu1
1Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, People's Republic of China.
Pain physician
|December 2, 2024
概括
连续胸部外围镇痛 (cTEA) 和连续胸部平面阻断 (cSAPB) 最好减少胸部手术后的阿片类药物消耗. 这些技术,以及直立脊柱平面阻断 (ESPB),也提供了优异的疼痛缓解.
科学领域:
- 麻醉学和疼痛管理
- 胸部外科手术 胸部外科手术
- 区域麻醉技术 区域麻醉技术
背景情况:
- 区域性镇痛对于急性和慢性疼痛的多式疼痛管理至关重要.
- 它在胸部手术中的应用广泛,但最佳技术仍然不清楚.
研究的目的:
- 系统地比较和排名各种区域止痛技术的疗效胸部手术.
- 确定最有效的术后疼痛控制方法.
主要方法:
- 一项系统性审查和对32项涉及1,996名患者的试验的网络元分析.
- 搜索了主要的数据库 (PubMed,Embase等) 在2023年1月之前.
- 使用CINeMA评估证据确定性;主要结局是24小时的阿片类药物消费.
主要成果:
- 连续胸部外围镇痛 (cTEA) 和连续状平面阻断 (cSAPB) 显示24小时阿片类药物消费的最大减少.
- cTEA,cSAPB和勃起脊柱平面块 (ESPB) 在6小时,12小时和24小时后显示了术后疼痛得分的显著改善.
- 连续外多阻断 (cEPB) 也减少了阿片类药物消费,但试验数据有限.
结论:
- 推使用cTEA和cSAPB来减少胸部手术后的阿片类药物消费.
- cTEA,cSAPB和ESPB对于在多个时间点管理术后疼痛是有效的.
- 需要进一步进行高质量的RCT来证实这些发现并优化区域止痛方案.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
359
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
359
Local Anesthetics: Clinical Application as Spinal Anesthesia
582
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...
582
Local Anesthetics: Clinical Application as Epidural Anesthesia
411
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
411
General Anesthesia: Overview
192
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
192
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
965
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
965
Analgesia and Pain Management
504
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
504


