对接受择期手术的儿科患者进行竖脊肌平面阻滞的镇痛效果和安全性：随机对照试验的系统回顾和 Meta 分析。

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-08-10 DOI:10.1016/j.jclinane.2024.111575

So Mee Park MD , Hyo Sung Kim MD , Byung Gun Lim MD, PhD

{"title":"对接受择期手术的儿科患者进行竖脊肌平面阻滞的镇痛效果和安全性：随机对照试验的系统回顾和 Meta 分析。","authors":"So Mee Park MD , Hyo Sung Kim MD , Byung Gun Lim MD, PhD","doi":"10.1016/j.jclinane.2024.111575","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><p>Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.</p></div><div><h3>Design</h3><p>Meta-analysis of randomized controlled trials.</p></div><div><h3>Setting</h3><p>Perioperative setting.</p></div><div><h3>Patients</h3><p>Pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Interventions</h3><p>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Measurements</h3><p>The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.</p></div><div><h3>Main results</h3><p>The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = −1.51; 95% confidence interval, −2.39 to −0.64; <em>P</em> = 0.0002; I<sup>2</sup> = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.</p></div><div><h3>Conclusions</h3><p>ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111575"},"PeriodicalIF":5.0000,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Analgesic efficacy and safety of erector spinae plane block in pediatric patients undergoing elective surgery: A systematic review and Meta-analysis of randomized controlled trials\",\"authors\":\"So Mee Park MD , Hyo Sung Kim MD , Byung Gun Lim MD, PhD\",\"doi\":\"10.1016/j.jclinane.2024.111575\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study objective</h3><p>Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.</p></div><div><h3>Design</h3><p>Meta-analysis of randomized controlled trials.</p></div><div><h3>Setting</h3><p>Perioperative setting.</p></div><div><h3>Patients</h3><p>Pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Interventions</h3><p>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Measurements</h3><p>The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.</p></div><div><h3>Main results</h3><p>The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = −1.51; 95% confidence interval, −2.39 to −0.64; <em>P</em> = 0.0002; I<sup>2</sup> = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.</p></div><div><h3>Conclusions</h3><p>ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.</p></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"98 \",\"pages\":\"Article 111575\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-08-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818024002046\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024002046","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

研究目的超声引导下竖脊平面阻滞（ESPB）常用于成人围术期镇痛，但其在儿科患者中的镇痛效果和安全性仍不确定。本综述旨在确定超声引导下的直立脊平面阻滞是否能提高小儿手术的镇痛效果和安全性：设计：随机对照试验的 Meta 分析：围手术期环境：患者：在全身麻醉下接受择期手术的小儿患者：我们检索了PubMed、Embase、Cochrane对照试验中央登记册、Cochrane系统综述数据库、KoreaMed、Web of Science、Scopus和ClinicalTrials.gov数据库，以寻找符合条件的已发表随机对照研究（RCT），这些研究比较了ESPB与对照组（无阻滞或其他阻滞）在全身麻醉下接受择期手术的儿科患者中的应用情况：主要结果是术后阿片类药物的累积用量。其他结果包括术中阿片类药物消耗量、首次请求镇痛抢救的时间、需要镇痛抢救的患者人数以及术后疼痛评分。安全性结果包括心动过缓、低血压和术后呕吐的发生率：主要结果：分析包括 17 项 RCT，共有 919 名参与者：ESPB组461人，无阻滞组（无阻滞/肱阻滞）269人，其他阻滞组189人。与对照组（无阻滞和其他阻滞）相比，ESPB显著减少了术后阿片类药物的累积用量（静脉注射吗啡毫克当量）（标准化平均差=-1.51；95%置信区间，-2.39至-0.64；P=0.0002；I2=92.9%）和术中阿片类药物的用量，并降低了术后24小时内的平均疼痛评分。ESPB延长了首次请求镇痛抢救的时间，减少了需要镇痛抢救的患者人数。此外，与无阻滞/肱阻滞相比，ESPB降低了术后24小时内大部分时间点的疼痛评分，提高了家长的满意度，并减少了术后呕吐的发生率：ESPB可为在全身麻醉下接受择期手术的小儿患者提供有效、安全的围术期镇痛。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

Analgesic efficacy and safety of erector spinae plane block in pediatric patients undergoing elective surgery: A systematic review and Meta-analysis of randomized controlled trials

Study objective

Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.

Design

Meta-analysis of randomized controlled trials.

Setting

Perioperative setting.

Patients

Pediatric patients undergoing elective surgery under general anesthesia.

Interventions

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and ClinicalTrials.gov databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.

Measurements

The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.

Main results

The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = −1.51; 95% confidence interval, −2.39 to −0.64; P = 0.0002; I² = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.

Conclusions

ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.