摘要:
目的 比较竖脊肌平面阻滞(erector spinae plane block,ESPB)与胸椎旁阻滞(thoracic paravertebral block,TPVB)预防乳腺癌患者急性术后疼痛(post-surgical pain syndrome,PSP)的疗效与安全性。方法 通过计算机检索Em-base、Cochrane library、Web of Science、PubMed、中国知网、维普、万方、中国生物医学文献数据库等国内外数据库中关于ESPB和TPVB在乳腺癌患者术后镇痛效果的临床随机对照试验(randomized controlled trial,RCT),检索时限为建库至2024年1月。采用Cochrane偏倚风险评估工具对纳入的文献进行质量评估,并采用Review Manager 5.4软件和Stata17.0软件进行Meta分析。结果 本研究共纳入14篇RCT,1079例患者,其中ESPB患者540例,TPVB患者539例。Meta分析结果表明,ESPB与TPVB术后3~4 h (I2=53%,SMD=0.36,95% CI:0.07~0.65,P=0.020)和5~6 h (I2=80%,SMD=0.53,95% CI:0.05~1.01,P=0.030)静息时疼痛评分差异具有统计学意义,即术后静息时TPVB镇痛效果优于ESPB;二者术后1~2 h (I2=75%,SMD=0.28,95% CI:-0.03~0.60,P=0.080)、7~8 h (I2=89%,SMD=0.24,95% CI:-0.47~0.94,P=0.510)、12 h (I2=90%,SMD=0.1,95% CI:-0.40~0.60,P=0.690)、24 h (I2=78%,SMD=0.33,95% CI:-0.04~0.70,P=0.080)、48 h (I2=85%,SMD=-0.05,95% CI:-0.52~0.42,P=0.830)静息时疼痛评分差异无统计学意义。ESPB与TPVB术后3~4 h (I2=0,SMD=0.29,95% CI:0.09~0.48,P=0.004)、7~8 h (I2=48%,SMD=0.37,95% CI:0.00~0.73,P=0.050)、48 h (I2=0,SMD=0.21,95% CI:0.03~0.39,P=0.020)运动时疼痛评分具有差异有统计学意义,即术后运动时TPVB镇痛效果优于ESPB;二者术后1~2 h (I2=89%,SMD=0.42,95% CI:-0.19~1.03,P=0.180)、5~6 h (I2=90%,SMD=0.29,95% CI:-0.67~1.24,P=0.560)、12 h (I2=81%,SMD=0.25,95% CI:-0.22~0.72,P=0.300)、24 h (I2=83%,SMD=0.39,95% CI:-0.10~0.89,P=0.120)运动时疼痛评分差异无统计学意义。ESPB神经阻滞操作时间短于TPVB,差异具有统计学意义(P<0.001)。ESPB与TPVB术后24 h阿片类药物消耗量、恶心呕吐发生率、PCIA泵首次按压时间差异无统计学意义(P均>0.05)。结论 与ESPB相比,TPVB阻滞效果吏段,但神经阻滞操作时间也更长。二者术后24 h阿片类药物消耗量、恶心呕吐发生率和PCIA泵首次按压时间无显著差异。
Abstract:
Objective To compare the efficacy and safety of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) in preventing acute post-surgical pain syndrome (PSP) OF BREAST CANCER. Methods The following databases, both domestic and international, including Embase, Cochrane Library, Web of Science, PubMed, CNKI, VIP, Wanfang, and Sinomed, were searched via computer to gather clinical randomized controlled trials (RCTs) on ESPB and TPVB for breast cancer patients. The included literature was evaluated using the Cochrane bias risk assessment tool to assess quality, and meta-analysis was performed using Review Manager 5. 4 software and Stata 17. 0 software. Results This study comprised 14 RCTs, with a total of 1079 patients, including 540 ESPB patients and 539 TPVB patients. The analysis results indicated that there was a significant difference in pain scores during postoperative rest between ESPB and TPVB during 3-4 h (I2=53%, SMD=0. 36, 95% CI:0. 07-0. 65, P=0. 020) and 5-6 h (I2=80%, SMD =0. 53, 95% CI:0. 05-1. 01, P=0. 030), with TPVB being superior to ESPB. However, there was no significant difference in pain scores during postoperative rest between ESPB and TPVB at 1-2 h (I2=75%, SMD =0. 28, 95% CI:-0. 03-0. 60, P=0. 080), 7-8 h (I2=89%, SMD=0. 24, 95% CI:-0. 47-0. 94, P= 0. 510), 12 h (I2=90%, SMD=0. 1, 95% CI:-0. 40-0. 60, P=0. 690), 24 h (I2=78%, SMD=0. 33, 95% CI:-0. 04-0. 70, P=0. 080), and 48 h (I2=85%, SMD=-0. 05, 95% CI:-0. 52-0. 42, P= 0. 830). For the pain score during postoperative exercise, there was a significant difference between ESPB and TPVB during 3-4 h (I2=0, SMD=0. 29, 95% CI:0. 09-0. 48, P=0. 004), 7-8 h (I2=48%, SMD= 0. 37, 95% CI:0. 00-0. 73, P=0. 050), and 48 h (I2=0, SMD=0. 21, 95% CI:0. 03-0. 39, P= 0. 020), with TPVB being superior to ESPB. There was no significant difference between ESPB and TPVB at 1-2 h (I2=89%, SMD=0. 42, 95% CI:-0. 19-1. 03, P=0. 180), 5-6 h (I2=90%, SMD=0. 29, 95% CI:-0. 67-1. 24, P=0. 560), 12 h (I2=81%, SMD=0. 25, 95% CI:-0. 22-0. 72, P=0. 300), and 24 h (I2=83%, SMD=0. 39, 95% CI:-0. 10-0. 89, P=0. 120). There was a statistical difference in the operation time of nerve blocks between the two methods, with ESPB taking less time than TPVB (P<0. 001). However, there was no statistical difference in opioid consumption within 24 h after surgery, incidence of nausea and vomiting, and the first PCIA press time (all P> 0. 05). Conclusions Compared to ESPB, TPVB tends to result in a decreased pain score after breast cancer surgery, but it also took longer to perform. There was no significant difference between the two methods in terms of opioid consumption at 24 h after surgery, incidence of nausea and vomiting and the first PCIA press time.
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