Sanja Pisljagic, Jens L Temberg, Mathias T Steensbæk, Sina Yousef, Mathias Maagaard, Lana Chafranska, Kai H W Lange, Christian Rothe, Lars H Lundstrøm, Anders K Nørskov
{"title":"桡骨远端骨折闭合复位术中的周围神经阻滞--系统综述、荟萃分析和试验序列分析。","authors":"Sanja Pisljagic, Jens L Temberg, Mathias T Steensbæk, Sina Yousef, Mathias Maagaard, Lana Chafranska, Kai H W Lange, Christian Rothe, Lars H Lundstrøm, Anders K Nørskov","doi":"10.1111/aas.14474","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults.</p><p><strong>Methods: </strong>We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction.</p><p><strong>Results: </strong>Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau<sup>2</sup> = 5.4, I<sup>2</sup> = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau<sup>2</sup> = 0.9, I<sup>2</sup> = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low.</p><p><strong>Conclusion: </strong>The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Peripheral nerve blocks for closed reduction of distal radius fractures-A systematic review with meta-analysis and trial sequential analysis.\",\"authors\":\"Sanja Pisljagic, Jens L Temberg, Mathias T Steensbæk, Sina Yousef, Mathias Maagaard, Lana Chafranska, Kai H W Lange, Christian Rothe, Lars H Lundstrøm, Anders K Nørskov\",\"doi\":\"10.1111/aas.14474\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults.</p><p><strong>Methods: </strong>We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction.</p><p><strong>Results: </strong>Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau<sup>2</sup> = 5.4, I<sup>2</sup> = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau<sup>2</sup> = 0.9, I<sup>2</sup> = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low.</p><p><strong>Conclusion: </strong>The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.</p>\",\"PeriodicalId\":6909,\"journal\":{\"name\":\"Acta Anaesthesiologica Scandinavica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Anaesthesiologica Scandinavica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/aas.14474\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Anaesthesiologica Scandinavica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/aas.14474","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/22 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：与其他更常用的方式相比，外周神经阻滞可为桡骨远端骨折的闭合复位提供更好的条件。在这篇系统性综述中，我们评估了有关外周神经阻滞用于成人桡骨远端骨折闭合复位术的效果和危害的现有证据：我们进行了荟萃分析和试验序列分析的系统性综述，其中包括对桡骨远端骨折闭合复位术中使用外周神经阻滞术进行调查的试验。共同主要结果为：(1)闭合复位的质量，即参与者术后需要手术的比例；(2)闭合复位过程中的疼痛：六项试验（n = 312）符合纳入标准。其中一项试验报告了手术需求，25 名接受神经阻滞的参与者中有 4 人需要手术，而 25 名接受血肿阻滞的参与者中有 7 人需要手术（RR 0.57，96.7% CI [0.19; 1.71]，p = .50）。四项试验报告了闭合复位术中的疼痛。在一项荟萃分析中，神经阻滞并没有在统计学上显著减轻疼痛（-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]）。没有跨越试验顺序界限，也没有达到所需的信息量。对评估超声引导下周围神经阻滞的试验（患者人数=110）进行预先计划的亚组分析表明，"减轻过程中的疼痛 "显著减轻（-4.1 NRS，96.7% CI [-5.5; -2.6]，p 2 = 0.9，I2 = 80%）。所有试验结果的偏倚风险都很高，证据的确定性很低：目前，桡骨远端骨折闭合复位术中外周神经阻滞效果的证据确定性非常低。在超声引导下进行外周神经阻滞可能会减轻闭合复位术中的疼痛。需要进行高质量的临床试验。
Peripheral nerve blocks for closed reduction of distal radius fractures-A systematic review with meta-analysis and trial sequential analysis.
Background: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults.
Methods: We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction.
Results: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low.
Conclusion: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.
期刊介绍：
Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.
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