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| 肩胛上神经阻滞与肌间沟神经阻滞用于肩关节镜手术的Meta分析 |
| Suprascapular nerve block versus interscalene nerve block for arthroscopic shoulder surgery: a meta-analysis |
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| DOI：10.12089/jca.2019.06.012 |
| 中文关键词: 肩胛上神经阻滞 肌间沟神经阻滞 肩关节镜手术 术后镇痛 Meta分析 |
| 英文关键词: Suprascapular nerve block Interscalene nerve block Arthroscopic shoulder surgery Postoperative analgesia Meta-analysis |
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| 中文摘要: |
目的 系统评价肩胛上神经阻滞（suprascapular nerve block, SNB）与肌间沟神经阻滞（interscalene nerve block, ISB）在肩关节镜手术中应用的安全性与有效性。
方法 检索PubMed、Embase、CENTRAL（2018年第3期）、中国知网、万方数据库、中国生物医学文献数据库（CBM），查找有关SNB与ISB应用于肩关节镜手术的随机对照试验，检索时限定义为建库至2018年4月。根据术后镇痛方法的不同将纳入分析的患者分为两组：SNB组和ISB组。采用RevMan 5.3软件进行Meta分析。
结果 最终可纳入本系统评价的文献11篇，共978例患者。Meta分析结果显示，静止状态下ISB组PACU疼痛评分明显低于SNB组（SMD=0.89，95%CI 0.50~1.29，P<0.01）。术后24 h静止状态下两组疼痛评分差异无统计学意义（SMD=-0.12，95%CI -0.25~0.01，P=0.07）。术后24 h活动状态下两组疼痛评分差异无统计学意义（SMD=-0.03，95%CI -0.56~0.50，P=0.92）。术后24 h内两组阿片类药物用量差异无统计学意义（SMD=0.06，95%CI -0.18~0.29，P=0.62）。SNB组PONV发生率明显低于ISB组（RR=0.56，95%CI 0.34~0.93，P=0.02）。SNB组Horner综合征发生率明显低于ISB组（RR=0.05，95%CI 0.01~0.23，P<0.01）。SNB组声音嘶哑发生率明显低于ISB组（RR=0.39，95%CI 0.19~0.81，P=0.01）。SNB组呼吸困难发生率明显低于ISB组（RR=0.25，95%CI 0.11~0.57，P<0.01）。
结论 与肌间沟神经阻滞比较，肩胛上神经阻滞能够为肩关节镜手术患者提供类似的术后镇痛效果且安全性更高，但在麻醉复苏期间镇痛效果欠佳。 |
| 英文摘要: |
Ojective To systematically evaluate the analgesic efficacy and safety of suprascapular nerve block versus interscalene nerve block for arthroscopic shoulder surgery.
Methods Databases including PubMed, Embase, Cochrane Library (Issue 3, 2018), CNKI, Wanfang data, CBM were searched to collect the randomized controlled trails (RCTs) about the analgesic efficacy and safety of suprascapular nerve block versus interscalene nerve block for arthroscopic shoulder surgery from inception to April 2018. Patients included in the analysis were divided into group SNB and group ISB according to different postoperative analgesia methods. The meta-analysis was conducted using RevMan 5.3 software.
Results Eleven RCTs involving 978 patients were included. The results of meta-analysis showed that the pain score in group ISB was lower than that in group SNB at PACU (SMD = 0.89, 95% CI 0.50 - 1.29, P < 0.01).There was no difference in pain scores at rest (SMD = -0.12, 95% CI -0.25 - 0.01, P = 0.07) or on movement (SMD = -0.03, 95% CI -0.56 - 0.50, P = 0.92) between the two groups at 24 h after operation. There was no difference in 24 h opioid consumption between the two groups (SMD = 0.06, 95% CI -0.18 - 0.29, P = 0.62). The incidence of PONV (RR = 0.56, 95% CI 0.34 - 0.93, P = 0.02), Horner syndrome (RR = 0.05, 95% CI 0.01 - 0.23, P < 0.01), hoarseness (RR = 0.39, 95% CI 0.19 - 0.81, P = 0.01) and dyspnea (RR = 0.25, 95% CI 0.11 - 0.57, P < 0.01) in group SNB were lower than those in group ISB.
Conclusion Compared with ISB, SNB with a higher safety can provide similar postoperative analgesic effect for the patients undergoing arthroscopic shoulder surgery with a higher safety, but the analgesic effect is not effective in PACU. |
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