比较短效/中效和长效局麻药用于周围神经阻滞的阻滞特性：一项系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-03-28 DOI:10.1016/j.bjane.2025.844617

Cheng Lin , Ana Larissa Guerrero , Joshua Jesin , Rohin Tangri , Nasong Anthony Luginaah , Kamal Kumar , Christopher Hansebout

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引用次数: 0

摘要

简介：混合局麻药（LA）的随机对照试验（RCTs）结果是相互矛盾的。我们进行了一项系统回顾和荟萃分析，研究使用混合物是否会导致手术阻滞更快发生。方法：对随机对照试验进行系统评价和荟萃分析。检索了从成立到2024年6月15日没有语言限制的Medline和Embase。纳入的随机对照试验必须比较混合LA和长效LA在成年外科患者神经阻滞的发作或持续时间。到手术阻滞的发病时间是主要观察指标。采用Cochrane偏倚风险工具和GRADE方法评估证据质量。结果：19项试验1060名受试者符合纳入标准。混合LA适度缩短了手术阻滞时间(-8.4分钟；95% CI -12.0 ~ -4.8分钟；p = 0.0001;I2 = 0.99)，感觉阻滞时间(-226.2分钟；95% CI -352.2 ~ -100.1分钟；p = 0.002;I2 = 0.98)和运动阻滞持续时间(-259.2分钟；95% CI -399.5 ~ -119.0分钟；p = 0.003;I2 = 0.98)，但没有时间到镇痛要求持续时间(-130.5分钟；95% CI -265.9 ~ 4.9分钟；p = 0.057;I2 = 0.98)。GRADE评分范围从低到非常低。结论：现有证据表明混合LA可适度减少手术阻滞潜伏期，但也缩短阻滞持续时间。未来的研究应评估混合LA在下肢阻滞中的作用，以及长效LA的最佳剂量，以平衡发病潜伏期和镇痛持续时间。普洛斯彼罗注册：CRD42024552801。

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Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis

Introduction

Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.

Method

We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.

Results

Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I² = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I² = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I² = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I² = 0.98). GRADE scoring ranged from low to very low.

Conclusion

The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.