Jeetinder K Makkar, Narinder P Singh, Bisman Jeet Kaur Khurana, Preet M Singh
{"title":"单针锯肌前平面阻滞与胸椎旁阻滞在乳房和胸外科手术围手术期的相对镇痛效果——随机对照试验的系统评价和荟萃分析。","authors":"Jeetinder K Makkar, Narinder P Singh, Bisman Jeet Kaur Khurana, Preet M Singh","doi":"10.4103/ija.ija_1027_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Various regional analgesia techniques, such as thoracic paravertebral (TPV) and serratus anterior plane (SAP) blocks, have been employed to manage postoperative pain following chest wall surgery. However, the comparative analgesic efficacy of these two approaches remains uncertain. This systematic review and meta-analysis aimed to assess the relative analgesic efficacy of these blocks in chest wall surgeries, including breast and thoracic procedures. The primary objective was the time to first rescue analgesia, and the secondary objective encompassed opioid consumption within 24 h, pain scores at different time intervals, opioid-related adverse effects and block-related complications.</p><p><strong>Methods: </strong>A systematic search for randomised controlled trials (RCTs) was conducted in PubMed, EMBASE and Scopus databases, covering studies from their inception to September 2023. We included active treatment arms from RCTs comparing these analgesic modalities. Statistical analysis was conducted in Review Manager Version 5.3, and results were analysed and reported separately for breast and thoracic surgery subgroups.</p><p><strong>Results: </strong>Eighteen trials enroling 1141 patients were included. Overall, no significant difference was observed in time to rescue analgesia, with a mean difference of 0.69 h (95% confidence interval -1.83, 0.45; <i>P</i> = 0.24, <i>I</i> <sup>2</sup> = 98%) between the SAP and TPV block groups. However, the TPV block demonstrated superior results for secondary outcomes in thoracic surgery patients. Complications related to the TPV block included pleural puncture and haematoma at the injection site.</p><p><strong>Conclusions: </strong>The evidence suggests that both blocks generally offer comparable analgesic efficacy for chest wall surgery patients, with the TPV block providing a slight advantage for those undergoing thoracic surgery.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 1","pages":"54-64"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878368/pdf/","citationCount":"0","resultStr":"{\"title\":\"Relative perioperative analgesic efficacy of single-shot serratus anterior plane block versus thoracic paravertebral block in breast and thoracic surgeries - A systematic review and meta-analysis of randomised controlled trials.\",\"authors\":\"Jeetinder K Makkar, Narinder P Singh, Bisman Jeet Kaur Khurana, Preet M Singh\",\"doi\":\"10.4103/ija.ija_1027_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Various regional analgesia techniques, such as thoracic paravertebral (TPV) and serratus anterior plane (SAP) blocks, have been employed to manage postoperative pain following chest wall surgery. However, the comparative analgesic efficacy of these two approaches remains uncertain. This systematic review and meta-analysis aimed to assess the relative analgesic efficacy of these blocks in chest wall surgeries, including breast and thoracic procedures. The primary objective was the time to first rescue analgesia, and the secondary objective encompassed opioid consumption within 24 h, pain scores at different time intervals, opioid-related adverse effects and block-related complications.</p><p><strong>Methods: </strong>A systematic search for randomised controlled trials (RCTs) was conducted in PubMed, EMBASE and Scopus databases, covering studies from their inception to September 2023. We included active treatment arms from RCTs comparing these analgesic modalities. Statistical analysis was conducted in Review Manager Version 5.3, and results were analysed and reported separately for breast and thoracic surgery subgroups.</p><p><strong>Results: </strong>Eighteen trials enroling 1141 patients were included. Overall, no significant difference was observed in time to rescue analgesia, with a mean difference of 0.69 h (95% confidence interval -1.83, 0.45; <i>P</i> = 0.24, <i>I</i> <sup>2</sup> = 98%) between the SAP and TPV block groups. However, the TPV block demonstrated superior results for secondary outcomes in thoracic surgery patients. Complications related to the TPV block included pleural puncture and haematoma at the injection site.</p><p><strong>Conclusions: </strong>The evidence suggests that both blocks generally offer comparable analgesic efficacy for chest wall surgery patients, with the TPV block providing a slight advantage for those undergoing thoracic surgery.</p>\",\"PeriodicalId\":13339,\"journal\":{\"name\":\"Indian Journal of Anaesthesia\",\"volume\":\"69 1\",\"pages\":\"54-64\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878368/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Anaesthesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/ija.ija_1027_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/11 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Anaesthesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/ija.ija_1027_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/11 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：各种区域镇痛技术，如胸椎旁（TPV）和前锯肌（SAP）阻滞，已被用于胸壁手术后疼痛的治疗。然而，这两种方法的比较镇痛效果仍然不确定。本系统综述和荟萃分析旨在评估这些阻滞在胸壁手术（包括乳房和胸部手术）中的相对镇痛效果。主要目标是首次抢救镇痛的时间，次要目标包括24小时内阿片类药物的消耗、不同时间间隔的疼痛评分、阿片类药物相关的不良反应和阻滞相关的并发症。方法：系统检索PubMed、EMBASE和Scopus数据库中的随机对照试验（RCTs），涵盖从研究开始到2023年9月的研究。我们从比较这些镇痛方式的随机对照试验中纳入了积极治疗组。在Review Manager Version 5.3中进行统计分析，分别对乳房和胸外科亚组的结果进行分析和报告。结果：纳入18项试验，纳入1141例患者。总体而言，两组在镇痛恢复时间上无显著差异，平均差异为0.69 h(95%可信区间-1.83,0.45；P = 0.24, i2 = 98%)。然而，在胸外科患者的次要预后方面，冠脉静脉阻滞显示出优越的效果。冠脉静脉阻滞的并发症包括胸膜穿刺和注射部位的血肿。结论：有证据表明，两种阻滞对胸壁手术患者的镇痛效果大致相当，TPV阻滞对接受胸壁手术的患者有轻微的优势。
Relative perioperative analgesic efficacy of single-shot serratus anterior plane block versus thoracic paravertebral block in breast and thoracic surgeries - A systematic review and meta-analysis of randomised controlled trials.
Background and aims: Various regional analgesia techniques, such as thoracic paravertebral (TPV) and serratus anterior plane (SAP) blocks, have been employed to manage postoperative pain following chest wall surgery. However, the comparative analgesic efficacy of these two approaches remains uncertain. This systematic review and meta-analysis aimed to assess the relative analgesic efficacy of these blocks in chest wall surgeries, including breast and thoracic procedures. The primary objective was the time to first rescue analgesia, and the secondary objective encompassed opioid consumption within 24 h, pain scores at different time intervals, opioid-related adverse effects and block-related complications.
Methods: A systematic search for randomised controlled trials (RCTs) was conducted in PubMed, EMBASE and Scopus databases, covering studies from their inception to September 2023. We included active treatment arms from RCTs comparing these analgesic modalities. Statistical analysis was conducted in Review Manager Version 5.3, and results were analysed and reported separately for breast and thoracic surgery subgroups.
Results: Eighteen trials enroling 1141 patients were included. Overall, no significant difference was observed in time to rescue analgesia, with a mean difference of 0.69 h (95% confidence interval -1.83, 0.45; P = 0.24, I2 = 98%) between the SAP and TPV block groups. However, the TPV block demonstrated superior results for secondary outcomes in thoracic surgery patients. Complications related to the TPV block included pleural puncture and haematoma at the injection site.
Conclusions: The evidence suggests that both blocks generally offer comparable analgesic efficacy for chest wall surgery patients, with the TPV block providing a slight advantage for those undergoing thoracic surgery.
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