Relative Perioperative Analgesic Efficacy of Superficial Versus Deep Approach of Serratus Anterior Plane Block for Anterior Chest Wall Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

IF 2.6 3区 医学 Q2 ANESTHESIOLOGY Clinical Journal of Pain Pub Date : 2024-12-01 DOI:10.1097/AJP.0000000000001249
Narinder P Singh, Jeetinder Kaur Makkar, Ira Dhawan, Neha Singh, Preet M Singh, Naveed Siddiqui
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Abstract

Objectives: Both superficial and deep serratus anterior plane (SAP) blocks are effective for anterior chest wall surgeries, but there is little clarity on which is more effective. Hence, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the comparative efficacy of the 2 approaches for SAP block after anterior chest wall surgery.

Materials and methods: A systematic literature search was performed using PubMed, Embase, Scopus, and Cochrane Central Registers of Controlled Trials for eligible RCTs from inception until August 2023. The primary outcome was opioid consumption during the first 24 hours of the postoperative period. The secondary outcomes included pain scores at various intervals, intraoperative opioid consumption, time to first analgesic request, block-related complications, opioid-related side effects, and patient satisfaction scores. Statistical analysis of the pooled data was performed using Review Manager Version 5.3.

Results: We identified 7 RCTs published between 2020 and 2022, enrolling 371 patients (186 in the superficial SAP block and 187 in the deep SAP block). Moderate certainty of evidence suggests that both the approaches (deep and superficial) of SAP block were comparable for 24-hour oral morphine equivalent consumption with a mean difference (MD) of 3.78 mg (95% CI: -1.70 to 9.29; P = 0.18; I2 = 87%). The results of other secondary outcomes were comparable, including resting pain scores with an MD of 0.08 (95% CI: -0.27 to 0.43; P = 0.67; I2 = 87%) for early pain and MD of 0.63 (95% CI: -1.28 to 0.01; P = 0.05; I2 = 95%) for late pain scores, time to first analgesic request with MD of -0.41 hour (95% CI: -1.40 to 0.59; P = 0.42; I2 = 90%), and incidence of postoperative nausea and vomiting (odds ratio: 1.45 (95% CI: 0.72 to 2.90; P = 0.30; I2 = 0%).

Conclusion: Current evidence does not support the preference for one approach of SAP block over the other for postoperative pain. Based on the available data, we recommend further future trials to determine any differences between these interventions.

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前胸壁手术中浅层与深层胸骨前平面阻滞围术期镇痛效果的比较:随机对照试验的系统回顾和元分析》。
目的:表层(s)和深层(d)锯肌前平面(SAP)阻滞对前胸壁手术都很有效,但哪种方法更有效还不清楚。因此,我们对随机对照试验 (RCT) 进行了系统性回顾和荟萃分析,以评估前胸壁手术后两种 SAP 阻滞方法的疗效比较:使用 PubMed、Embase、Scopus 和 Cochrane Central Registers of Controlled Trials 对从开始到 2023 年 8 月符合条件的 RCT 进行了系统性文献检索。主要结果是术后 24 小时内阿片类药物的消耗量。次要结果包括不同时间间隔的疼痛评分、术中阿片类药物消耗量、首次申请镇痛药的时间、阻滞相关并发症、阿片类药物相关副作用以及患者满意度评分。使用Review Manager 5.3版对汇总数据进行了统计分析:我们确定了在 2020 年至 2022 年间发表的 7 项 RCT,共招募了 371 名患者(186 名患者接受了 sSAP 阻滞治疗,187 名患者接受了 dSAP 阻滞治疗)。中度确定性证据表明,两种 SAP 阻滞方法(深部和浅部)的 24 小时口服吗啡当量消耗量相当,平均差异 (MD) 为 3.78 毫克(95% CI -1.70 至 9.29;P=0.18;I2=87%)。其他次要结果的结果具有可比性,包括静息疼痛评分,早期疼痛的 MD 为 0.08 (95% CI -0.27 to 0.43; P=0.67; I2=87%) ,MD 为 0.63 (95% CI -1.28 to 0.01; P=0.晚期疼痛评分的MD为0.63(95% CI -1.28 to 0.01;P=0.05;I2=95%),首次申请镇痛药时间的MD为-0.41小时(95% CI -1.40 to 0.59;P=0.42;I2=90%),PONV的发生率(OR,1.45(95% CI 0.72 to 2.90;P=0.30;I2=0%):讨论:目前的证据并不支持在术后疼痛治疗中优先选择一种 SAP 阻滞方法。根据现有数据,我们建议今后进一步开展试验,以确定这些干预措施之间是否存在差异。
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来源期刊
Clinical Journal of Pain
Clinical Journal of Pain 医学-临床神经学
CiteScore
5.40
自引率
3.40%
发文量
118
审稿时长
4-8 weeks
期刊介绍: ​​​The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.
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