Effects of different neuraxial analgesia modalities on the need for physician interventions in labour: A network meta-analysis.

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2024-06-01 Epub Date: 2024-03-28 DOI:10.1097/EJA.0000000000001986
Lizhong Wang, Jiayue Huang, Xiangyang Chang, Feng Xia
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引用次数: 0

Abstract

Background: Neuraxial labour analgesia can be initiated with epidural (EPL), combined spinal epidural (CSE) or dural puncture epidural (DPE) and maintained with continuous epidural infusion (CEI), patient-controlled epidural analgesia (PCEA) or programmed intermittent epidural bolus (PIEB), but the optimal analgesia modality is still controversial.

Objective: To compare the effects of commonly used neuraxial analgesia modalities on the proportion of women needing physician interventions, as defined by the need for physician-administered epidural top-ups for inadequate analgesia in labour.

Design: Bayesian network meta-analysis.

Data sources: PubMed, Embase, CENTRAL, Web of Science and Wanfang Data were searched from January 1988 to August 2023 without language restriction.

Eligibility criteria: Randomised controlled trials comparing two or more modalities of the following six neuraxial analgesia modalities in healthy labouring women: EPL+CEI+PCEA, EPL+PIEB+PCEA, CSE+CEI+PCEA, CSE+PIEB+PCEA, DPE+CEI+PCEA and DPE+PIEB+PCEA.

Results: Thirty studies with 8188 women were included. Compared with EPL+CEI+PCEA, EPL+PIEB+PCEA [odds ratio (OR) = 0.44; 95% credible interval (CrI), 0.22 to 0.86], CSE+PIEB+PCEA (OR = 0.29; 95% CrI, 0.12 to 0.71) and DPE+PIEB+PCEA (OR = 0.19; 95% CrI, 0.08 to 0.42) significantly reduced the proportion of women needing physician interventions. DPE+PIEB+PCEA had fewer women needing physician interventions than all other modalities, except for CSE+PIEB+PCEA (OR = 0.63; 95% CrI, 0.25 to 1.62). There were no significant differences in local anaesthetic consumption, maximum pain score, and the incidence of instrumental delivery between the different neuraxial modalities.

Conclusions: PIEB+PCEA is associated with a lower risk of physician interventions in labour than CEI+PCEA. DPE or CSE and PIEB+PCEA may be associated with a lower likelihood of physician interventions than other neuraxial modalities. Otherwise, the new neuraxial analgesia techniques do not appear to offer significant advantages over traditional techniques. However, these results should be interpreted with caution due to limited data and methodological limitations.

Trial registration: PROSPERO (CRD42023402540).

不同神经镇痛模式对分娩时医生干预需求的影响:网络荟萃分析。
背景:神经轴性分娩镇痛可以通过硬膜外(EPL)、联合脊髓硬膜外(CSE)或硬膜穿刺硬膜外(DPE)来启动,并通过连续硬膜外输注(CEI)、患者控制硬膜外镇痛(PCEA)或程序间歇硬膜外栓剂(PIEB)来维持,但最佳镇痛方式仍存在争议:目的:比较常用神经镇痛模式对需要医生干预的产妇比例的影响:贝叶斯网络荟萃分析:数据来源:PubMed、Embase、CENTRAL、Web of Science和万方数据,检索时间为1988年1月至2023年8月,无语言限制:在健康产妇中比较以下六种神经镇痛方式中的两种或两种以上方式的随机对照试验:EPL+CEI+PCEA、EPL+PIEB+PCEA、CSE+CEI+PCEA、CSE+PIEB+PCEA、DPE+CEI+PCEA和DPE+PIEB+PCEA:共纳入了 30 项研究,涉及 8188 名妇女。与EPL+CEI+PCEA相比,EPL+PIEB+PCEA[几率比(OR)=0.44;95%可信区间(CrI),0.22至0.86]、CSE+PIEB+PCEA(OR=0.29;95%CrI,0.12至0.71)和DPE+PIEB+PCEA(OR=0.19;95%CrI,0.08至0.42)显著降低了需要医生干预的妇女比例。除CSE+PIEB+PCEA(OR = 0.63; 95% CrI, 0.25 to 1.62)外,DPE+PIEB+PCEA需要医生干预的女性人数少于所有其他方式。在局麻药消耗量、最大疼痛评分和器械助产发生率方面,不同神经经管模式之间没有明显差异:结论:与CEI+PCEA相比,PIEB+PCEA的产程中医生干预的风险更低。与其他神经经管方式相比,DPE或CSE和PIEB+PCEA可能与较低的医生干预相关。除此之外,新的神经轴镇痛技术与传统技术相比似乎并无明显优势。然而,由于数据有限和方法上的局限性,在解释这些结果时应谨慎:试验注册:prospero (CRD42023402540)。
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
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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