乳腺癌手术后术后疼痛的区域镇痛技术:一个网络元分析
Pascal Rd Clephas1, Sharon Orbach-Zinger2, Martina A Gosteli-Peter3
1Erasmus Medical Center, Rotterdam, Netherlands.
The Cochrane database of systematic reviews
|June 4, 2025
概括
区域性镇痛技术,如椎阻断 (PVB),直立脊柱平面阻断 (ESPB),胸部神经阻断 (PEC) 和前平面阻断 (SAPB) 在减少乳腺癌手术后的术后疼痛和并发症方面表现出相似的有效性.
科学领域:
- 麻醉学和疼痛管理
- 手术瘤学手术瘤学
- 基于证据的医学基于证据的医学.
背景情况:
- 手术后的疼痛是乳腺癌手术后的一个重要问题.
- 区域止痛技术对于管理这种疼痛至关重要,但具有固有的风险.
研究的目的:
- 在接受乳腺癌手术的妇女中评估各种区域止痛技术的止痛效果和安全性.
- 为了比较准脊椎阻塞 (PVB),直立脊柱平面阻塞 (ESPB),胸部神经阻塞 (PEC) 和前平面阻塞 (SAPB).
主要方法:
- 在多个数据库 (CENTRAL,MEDLINE,Embase,CINAHL,Scopus,Web of Science) 进行了系统的搜索.
- 包括随机对照试验 (RCT),比较两个或三个指定的区域块.
- 网络元分析 (NMAs) 使用随机效应模型进行,证据确定性由CINeMA.
主要成果:
- 大多数技术在减轻休息和运动期间的术后疼痛方面表现出相似的有效性,在2,24小时和48小时后.
- 胸部神经阻塞 (PEC) 在一些疼痛评估中显示出轻微的,但在临床上没有显著的优势,相对于准脊椎阻塞 (PVB).
- 在包括的研究中没有报告与区域止痛相关的并发症,尽管由于样本大小小和信任区间宽,证据确定性往往很低.
结论:
- 评估的区域止痛技术在缓解术后疼痛和最大限度地减少乳腺癌手术后并发症的能力方面似乎是可比的.
- 需要对更大的样本进行进一步的研究,以最终评估并发症率和止痛药的使用.
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