Xiaojing Wei, Zhongqiang Liu, Chong Liu, Shukai Li, Jing An, Zhixue Wang
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Based on scalp block operation time (preoperative block, postoperative block), different control groups (no block, normal saline), local anesthetic types (bupivacaine, levobupivacaine, ropivacaine), the postoperative pain score at different time points was analyzed by subgroup analysis.</p><p><strong>Results: </strong>23 studies involving 1515 patients were included. The combined results showed that SNB could significantly reduce the pain scores at all time points compared with the control group (P < .05). Subgroup analysis showed that the analgesic effect of preoperative scalp nerve block was better than that of postoperative block, and the effect of ropivacaine and levobupivacaine was better than bupivacaine. SNB could reduce morphine consumption within 48 hours after surgery (SMD = -1.51, 95% CI -2.80 -0.21, P = .02, I2 = 89%). The first rescue analgesia time was significantly longer in the SNB group than the control group (SMD = 0.57, 95% CI 0.16-0.99, P = .01, I2 = 68.76%). 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引用次数: 0
摘要
目的通过荟萃分析评估头皮神经阻滞（SNB）对开颅手术患者术后镇痛和应激反应的影响：方法： 在PubMed、Embase、Cochrane Library、CNKI和万方数据库中检索了从开始到2022年8月1日期间涉及全身麻醉下选择性开颅手术SNB的随机对照试验。使用 RevMan 5.4 和 Stata MP17.0 进行了 Meta 分析。根据头皮阻滞操作时间（术前阻滞、术后阻滞）、不同对照组（无阻滞、生理盐水）、局麻药类型（布比卡因、左布比卡因、罗哌卡因），对不同时间点的术后疼痛评分进行亚组分析。综合结果显示，与对照组相比，SNB 可显著降低所有时间点的疼痛评分（P < .05）。亚组分析显示，术前头皮神经阻滞的镇痛效果优于术后阻滞，罗哌卡因和左旋布比卡因的效果优于布比卡因。SNB可减少术后48小时内的吗啡用量（SMD = -1.51, 95% CI -2.80 -0.21，P = .02，I2 = 89%）。SNB组首次镇痛抢救时间明显长于对照组（SMD = 0.57，95% CI 0.16-0.99，P = .01，I2 = 68.76%）。与对照组相比，术后血管紧张素水平、术中血糖水平以及术中和术后皮质醇水平均显著下降（P < .05）。头皮神经阻滞能抑制手术刺激引起的血流动力学变化，有效降低术后恶心和呕吐的发生率（RR = 0.71，95% CI 0.51~0.97，P = .03）：结论：头皮神经阻滞是一种有效的镇痛剂，可在开颅手术后 48 小时内减轻疼痛。结论：头皮神经阻滞是一种有效的镇痛药，可在开颅手术后 48 小时内减轻疼痛，有效抑制手术刺激引起的应激反应，稳定血流动力学，降低术后恶心和呕吐的发生率。
The Effect of Scalp Nerve Block on Postoperative Analgesia and Stress Response in Patients Undergoing Craniotomy: A Meta-Analysis.
Objective: To evaluate the effect of scalp nerve block (SNB) on postoperative analgesia and stress response in patients undergoing craniotomy by meta-analysis.
Methods: PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases were searched for randomized controlled trials involving SNB for elective craniotomy under general anesthesia from inception to August 1, 2022. Meta-analysis was performed using RevMan 5.4 and Stata MP17.0. Based on scalp block operation time (preoperative block, postoperative block), different control groups (no block, normal saline), local anesthetic types (bupivacaine, levobupivacaine, ropivacaine), the postoperative pain score at different time points was analyzed by subgroup analysis.
Results: 23 studies involving 1515 patients were included. The combined results showed that SNB could significantly reduce the pain scores at all time points compared with the control group (P < .05). Subgroup analysis showed that the analgesic effect of preoperative scalp nerve block was better than that of postoperative block, and the effect of ropivacaine and levobupivacaine was better than bupivacaine. SNB could reduce morphine consumption within 48 hours after surgery (SMD = -1.51, 95% CI -2.80 -0.21, P = .02, I2 = 89%). The first rescue analgesia time was significantly longer in the SNB group than the control group (SMD = 0.57, 95% CI 0.16-0.99, P = .01, I2 = 68.76%). Compared with the control group, the levels of postoperative angiotensin, intraoperative blood glucose, and both intraoperative and postoperative cortisol levels were significantly decreased (P < .05). SNB can inhibit hemodynamic changes caused by surgical stimulation and effectively reduce the incidence of postoperative nausea and vomiting (RR = 0.71, 95% CI 0.51~0.97, P = .03).
Conclusion: Scalp nerve block is an effective analgesic that reduces pain within 48 hours after craniotomy. It effectively inhibit the stress response caused by surgical stimulation, stabilize hemodynamics, and reduce the incidence of postoperative nausea and vomiting.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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