Combination of shorter and longer-acting LA vs. longer-acting LA for brachial plexus block: Systematic review and meta-analysis of randomized clinical trials

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-22 DOI:10.1016/j.jclinane.2025.112017

Adeeb Oweidat MD, DESAIC, EDRA , Carla R. Hightower MD, MBA , Vishal Uppal FRCA , Hari Kalagara MD , Nada Sadek MD , Melinda S. Seering MD , Chris Childs MS , Rakesh V. Sondekoppam MBBS, MD

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引用次数: 0

Abstract

Background

Combining shorter-acting local anesthetics (LA) with longer-acting ones should theoretically ensure a quick-onset block without compromising on the duration of blockade. We wanted to perform a review of literature evaluating combination of shorter-acting and longer-acting LA in comparison to long-acting LA alone when used for brachial plexus blocks in terms of block characteristics and efficacy.

Methods

Primary literature searches were performed in PubMed, Embase, and the Cochrane databases from their inception through October 26, 2023. Randomized clinical trials (RCTs) utilizing any combination of mixtures of a shorter and longer-acting LA (combination LA) compared to any single long-acting LA for brachial plexus block in adults were selected. The primary outcomes of interest were sensory and motor block onset times while secondary outcomes included duration of blockade, duration of analgesia and, the need for conversion to general anesthesia (GA).

Results

A total of 4209 primary references were reviewed and after exclusions, 11 RCTs were included for data extraction. Pooled data showed that compared to long-acting LA, combination of LAs did not reduce the sensory onset time [MD (95 % CI) -0.44 min (−0.89; 0.02)] nor the motor onset [MD (95 % CI): 0.01 (−1.30 to 1.32)]. The combination group showed a shorter duration of sensory and motor blockade without differences in other secondary outcomes.

Conclusion

Our meta-analysis of RCTs indicate that combination of shorter and long acting LAs did not provide benefit in terms of onset time while leading to notably shorter durations of sensory and motor blockade compared to longer acting LA alone when used in brachial plexus blocks.

PROSPERO registration no.: CRD42023476579.

查看原文本刊更多论文

联合使用短效和长效LA vs长效LA治疗臂丛神经阻滞：随机临床试验的系统评价和荟萃分析

将作用较短的局麻药（LA）与作用较长的局麻药结合使用，理论上可以确保在不影响阻滞持续时间的情况下实现快速阻滞。我们希望对文献进行回顾，以评估短效和长效LA联合应用于臂丛神经阻滞时的阻滞特性和疗效，并与单独使用长效LA进行比较。方法从PubMed、Embase和Cochrane数据库建立至2023年10月26日进行初步文献检索。选择随机临床试验（rct），使用任何短期和长期作用的LA（联合LA）的组合，与任何单一的长效LA相比，用于成人臂丛神经阻滞。主要结局是感觉和运动阻滞发作时间，次要结局包括阻滞持续时间、镇痛持续时间和是否需要转全身麻醉（GA）。结果共纳入4209篇主要文献，剔除后纳入11篇rct进行数据提取。综合数据显示，与长效LA相比，联合使用LA并没有减少感觉发病时间[MD (95% CI): -0.44 min(- 0.89; 0.02)]，也没有减少运动发病时间[MD (95% CI): 0.01(- 1.30至1.32)]。联合用药组感觉和运动阻滞持续时间较短，其他次要结果无差异。结论：我们对随机对照试验的荟萃分析表明，在臂丛神经阻滞中，与单独使用长效LA相比，联合使用长效和短效LA在起效时间上并没有带来益处，但会导致感觉和运动阻滞的持续时间明显缩短。普洛斯彼罗注册号：: CRD42023476579。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.