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.
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