外侧斜肋间平面块用于术后止痛:随机对照试验的系统审查和元分析
Anita Saran1, Wasimul Hoda2, Khushboo Pandey1
1Assistant Professor, Department of Anaesthesia, All India Institute of Medical Sciences, Rajkot, Gujarat, India.
外侧斜肋间平面 (EOIP) 块在腹部手术后提供有效的疼痛缓解,显著减少阿片类药物的使用,改善恢复. 需要进一步的研究来比较它的好处与其他区域麻醉技术.
科学领域:
- 麻醉学和疼痛管理
- 术后恢复 术后恢复
- 区域麻醉技术 区域麻醉技术
背景情况:
- 外侧斜肋间平面 (EOIP) 块是一种表面区域麻醉技术,用于腹壁上部止痛.
- 它针对T6-T10间肋间神经,在腹部外科手术中为多模式止痛提供了一个有希望的选择.
- 它在仰卧姿势中易于执行,提高了其临床适用性.
研究的目的:
- 在接受腹部手术的成年人中系统地审查和元分析EOIP阻断的疗效.
- 为了比较EOIP块与其他形平面块,伤口透和无块干预.
- 评估其对术后疼痛,阿片类药物消费和康复结果的影响.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析是按照PRISMA指南进行的.
- 这项分析包括了涉及1032名患者的17个RCT.
- 主要结局是手术后24小时的阿片类药物消耗;次要结局包括疼痛评分,手术期间的阿片类药物使用和恢复质量.
主要成果:
- 与没有阻断相比,EOIP阻断显著降低了24小时的阿片类药物消费 (SMD: -1.32;P < 0.001).
- 它还降低了疼痛评分,手术期间使用芬太尼,以及术后恶心和吐 (PONV) 的发生率.
- 观察到恢复质量的改善 (QoR) -15分数和延长疼痛缓解的持续时间.
结论:
- EOIP 阻断显示出显著的阿片类药物节约效应,并增强了腹部手术中的恢复.
- 它提供持续的疼痛缓解,并减少了救援止痛的需要.
- 虽然没有确的证据证明没有块,但建议进一步进行高质量的RCT,以将EOIP与其他形平面块进行比较,因为异质性和中等证据确定性.
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