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关注罂粟花，共同学习麻醉学最新文献！ 腰椎手术中竖脊肌平面阻滞镇痛效果的系统评价和Meta分析
贵州医科大学 麻醉与心脏电生理课题组 翻译：潘志军 编辑：潘志军 审校：曹莹 研究目的：竖脊肌平面阻滞（ESPB）在各种外科手术中用于围手术期镇痛已得到广泛应用。然而，其在腰椎手术中的疗效尚不清楚。本综述旨在确定ESPB是否能提高腰椎手术的镇痛效果。 试验设计：一项随机对照试验Meta分析。 范围设置：围手术期。 受试人群：在全身麻醉下接受腰椎手术的患者。 干预因素：我们在PubMed、Cochrane图书馆、EMBASE、科学网等数据库中搜索已发表的符合纳入标准的对照试验，比较ESPB与对照组（无阻滞/假阻滞）在腰椎手术中的作用。 测定方法：主要结果是术后24小时内阿片类药物的使用量。 主要结果：12项研究共包括665名参与者。与对照组相比，ESPB在术后24小时显著减少了阿片类药物（吗啡毫克当量）的消耗量[平均差异（MD）=−14.55; 95%置信区间（CI），−21.03至−8.07; P<0.0001]，并在术后48小时内不同时间点（休息或运动时）具有更低的疼痛评分。ESPB提高了患者满意度评分（0−10） （MD=2.38；95%CI，2.10至2.66；P<0.0001），减少了术后恶心呕吐[风险比（RR）=0.36；95%CI，0.20至0.67；P=0.001]，并缩短了住院时间（MD=−1.24天；95%置信区间，−2.31至−0.18; P=0.02）。此外，亚组分析显示，与其它固定胸/腰椎层面相比,在越靠近切口/手术的椎体层面行ESPB后阿片消耗量额外减少。然而，观察到相当多的异质性和证据质量低下。
 结论：ESPB提供了有效的术后镇痛，与对照组相比，接受腰椎手术的患者术后恶心呕吐减少，患者满意度和恢复情况更好。然而，证据的低质量削弱了调查结果，因此需要进一步的高质量证据。 原始文献来源 👇 Seok Kyeong Oh, Byung Gun Lim, Young Ju Won,et al.,et al.Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis [J]. (J Clin Anesth 2022 Jan 11;78). 英文原文 Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis Abstract Study objective: Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. Design: A meta-analysis of randomized controlled trials. Setting: Perioperative setting. Patients: Patients undergoing lumbar spine surgery under general anesthesia. Interventions: We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery. Measurements: The primary outcome was opioid consumption in the first 24 h after surgery. Main results: Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = −14.55; 95% confidence interval (CI), −21.03 to −8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0−10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = −1.24 days; 95% CI, −2.31 to −0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed. Conclusions: ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. 谢谢您的点赞、分享、在看， 欢迎您的精彩评论哦 更多精彩，请关注公众号：罂粟花
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