Optimal local anesthetic for spinal anesthesia in patients undergoing ambulatory non-arthroplasty surgery: a systematic review and Bayesian network meta-analysis of randomized controlled trials.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-04-01 Epub Date: 2025-04-08 DOI:10.1007/s12630-025-02924-4

Narinder P Singh, Naveed T Siddiqui, Jeetinder K Makkar, Ryan Guffey, Preet M Singh

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引用次数: 0

Abstract

Purpose: Dosing and types of local anesthetic agents for spinal anesthesia in ambulatory settings vary significantly. We sought to conduct a network meta-analysis to evaluate the effect of the type and dose of local anesthetic on outcomes in patients undergoing ambulatory surgery.

Methods: After PROSPERO registration (CRD42023399356), we searched various databases for randomized controlled trials (RCTs) evaluating adult patients undergoing daycare surgery under spinal anesthesia. Most included trials focused on patients undergoing knee arthroscopy, while other covered procedures were perineal, lower abdominal, and limb surgeries. Unfortunately, we could not include trials on arthroplasty surgery owing to the lack of RCTs in this area. We used Confidence in Network Meta-Analysis (CINeMA) to assess the confidence in the estimates, and we used surface under the cumulative ranking curve (SUCRA) to determine the probability rank order. The primary outcome was the time to discharge. Intraoperative effectiveness of anesthetic, sensory, and motor blockade duration; time to first micturition; time to ambulation; and adverse effects such as urinary retention and transient neurologic symptoms (TNS) were the secondary outcomes.

Results: Overall, this study included 44 trials comprising 3,299 patients, each comprising 11 distinct agents (2-chloroprocaine, articaine, high-dose bupivacaine, low-dose bupivacaine, lidocaine, high-dose levobupivacaine, low-dose levobupivacaine, mepivacaine, prilocaine, high-dose ropivacaine, and low-dose ropivacaine). Low- to moderate-certainty evidence showed that 2-chloroprocaine, lidocaine, and mepivacaine were superior for discharge readiness, while 2-chloroprocaine ranked highest for other outcomes (sensory and motor block duration, time to first ambulation, and spontaneous voiding).

Conclusions: Evidence supports 2-chloroprocaine for short-duration spinal anesthesia in the ambulatory setting.

Study registration: PROSPERO ( CRD42023399356 ); first submitted 13 February 2023.

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非关节成形术患者脊柱麻醉的最佳局部麻醉：随机对照试验的系统回顾和贝叶斯网络荟萃分析。

目的：门诊脊髓麻醉局麻药的剂量和种类差异很大。我们试图进行一项网络荟萃分析，以评估局部麻醉的类型和剂量对门诊手术患者预后的影响。方法：在PROSPERO注册（CRD42023399356）后，我们检索了各种数据库中评估脊髓麻醉下日托手术成人患者的随机对照试验（RCTs）。大多数纳入的试验集中于接受膝关节镜检查的患者，而其他涵盖的手术包括会阴、下腹部和肢体手术。不幸的是，由于缺乏该领域的随机对照试验，我们无法纳入关节成形术的试验。我们使用Confidence in Network Meta-Analysis （CINeMA）来评估估计的置信度，使用surface under the cumulative ranking curve （SUCRA）来确定概率排序顺序。主要观察指标为出院时间。术中麻醉、感觉和运动阻断持续时间的有效性；第一次排尿时间；走动的时间；尿潴留和短暂性神经系统症状（TNS）等不良反应是次要结局。结果：总体而言，该研究包括44项试验，包括3,299名患者，每项试验包括11种不同的药物（2-氯普鲁卡因、阿替卡因、高剂量布比卡因、低剂量布比卡因、利多卡因、高剂量左旋布比卡因、低剂量左旋布比卡因、甲哌卡因、普利洛卡因、高剂量罗哌卡因和低剂量罗哌卡因）。低至中等确定性证据表明，2-氯普鲁卡因、利多卡因和甲哌卡因在出院准备方面优于2-氯普鲁卡因，而2-氯普鲁卡因在其他结果（感觉和运动阻滞持续时间、首次下床时间和自然排尿）方面排名最高。结论：有证据支持2-氯普鲁卡因用于门诊短时间脊髓麻醉。研究注册：PROSPERO (CRD42023399356)；首次提交于2023年2月13日。

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

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.