Conventional anatomical landmark versus preprocedural ultrasound for thoracic epidural analgesia: A systematic review and meta-analysis.

IF 1.2 Q3 SURGERY

Journal of perioperative practice Pub Date : 2024-10-01 Epub Date: 2023-09-13 DOI:10.1177/17504589231181974

Mahfouz Sharapi, Amany Mahfouz, Kerollos Philip, Ammar Mektebi, Khaled Albakri

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引用次数: 0

Abstract

Background: Thoracic epidural analgesia is the gold standard for major thoracic and abdominal surgeries.

Aim: Ultrasound-guided and landmark-based thoracic epidural insertion are compared in this systematic review.

Methods: Randomised controlled trials were sought in six databases for a systematic review and meta-analysis. With a 95% confidence interval, a fixed-effects model calculated risk ratio or mean difference. Cochrane risk of bias assessed bias. Four randomised controlled trials were examined.

Findings: Preprocedural ultrasound increased thoracic epidural placement first-puncture success rate (risk ratio = 1.28, 95% confidence interval (1.05 to 1.56), p value = 0.02) and decreased the need for two or more skin punctures (mean difference = -2.41, 95% confidence interval (-3.34 to -1.47), p value = 0.00001). The ultrasound group reduced needle redirections (risk ratio = 0.6, 95% confidence interval (0.38 to 0.94), p value = 0.02). The epidural block success rate was equal in both groups (risk ratio = 1.02, 95% confidence interval (0.96 to 1.07), p value = 0.6).

Conclusion: Thoracic epidural insertion is improved by ultrasound but not the success rate. Quality research with larger samples is needed to emphasise these conclusions.

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胸腔硬膜外镇痛的传统解剖标志与术前超声：系统回顾和荟萃分析。

背景：目的：本系统综述比较了超声引导和基于地标的胸硬膜外插入：方法：在六个数据库中寻找随机对照试验，进行系统回顾和荟萃分析。通过 95% 的置信区间，固定效应模型计算出风险比或平均差异。Cochrane 偏倚风险对偏倚进行了评估。对四项随机对照试验进行了研究：术前超声提高了胸硬膜外置管首次穿刺成功率（风险比=1.28，95%置信区间（1.05~1.56），P值=0.02），减少了两次或两次以上皮肤穿刺的需要（平均差=-2.41，95%置信区间（-3.34~-1.47），P值=0.00001）。超声组减少了针头重定向（风险比 = 0.6，95% 置信区间（0.38 至 0.94），P 值 = 0.02）。两组的硬膜外阻滞成功率相同（风险比 = 1.02，95% 置信区间（0.96 至 1.07），P 值 = 0.6）：结论：超声可改善胸膜硬膜外插入，但不能提高成功率。结论：超声可提高胸椎硬膜外插入率，但不能提高成功率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of perioperative practice Nursing-Medical and Surgical Nursing

CiteScore

1.60

自引率

0.00%

发文量

期刊介绍： The Journal of Perioperative Practice (JPP) is the official journal of the Association for Perioperative Practice (AfPP). It is an international, peer reviewed journal with a multidisciplinary ethos across all aspects of perioperative care. The overall aim of the journal is to improve patient safety through informing and developing practice. It is an informative professional journal which provides current evidence-based practice, clinical, management and educational developments for practitioners working in the perioperative environment. The journal promotes perioperative practice by publishing clinical research-based articles, literature reviews, topical discussions, advice on clinical issues, current news items and product information.