Soroush Oraee, Shahryar Rajai Firouzabadi, Ida Mohammadi, Mohammadreza Alinejadfard, Hossein Golsorkh, Sara Hatami
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We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model.</p><p><strong>Results: </strong>ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis.</p><p><strong>Conclusion: </strong>ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile.</p><p><strong>Trial registration: </strong>Prospero registration ID: CRD42024508363. 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引用次数: 0
摘要
背景：腹直肌平面阻滞（ESPB）是一种新型镇痛技术，可减少腹腔镜手术中的术后疼痛和术后阿片类药物的用量：我们于 2023 年 11 月 17 日在 PubMed、Scopus 和 Web of Science 上搜索了比较 ESPB 与其他腹腔镜手术镇痛技术或安慰剂的临床试验。我们使用随机效应模型对术后静息痛、术后阿片类药物消耗量、首次请求救援镇痛剂的时间以及术后恶心和呕吐进行了荟萃分析：结果：与安慰剂相比，ESPB明显减少了阿片类药物的用量（SMD，（95CI），P值；-1.837，（-2.331，-1.343），结论：ESPB是一种有效、安全的镇痛药：与安慰剂相比，ESPB 是一种有效且安全的镇痛技术，可有效控制腹腔镜手术的术后疼痛和阿片类药物消耗，同时还能减少术后恶心或呕吐。与其他技术相比，ESPB除了在术后24小时的疼痛评分方面与QLB具有相似的疗效，但作为腹腔镜手术的镇痛技术，ESPB似乎优于TAPB，且具有相似的安全性：试验注册：Prospero 注册 ID：试验注册：Prospero 注册编号：CRD42024508363。链接：https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis.
Background: Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries.
Methods: We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model.
Results: ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis.
Conclusion: ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile.
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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