神经麻醉下剖宫产术中疼痛：系统回顾和荟萃分析。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

Anesthesiology Pub Date : 2025-04-04 DOI:10.1097/ALN.0000000000005486

Elinor A Charles, Hester Carter, Susanna Stanford, Lindsay Blake, Victoria Eley, Brendan Carvalho, Pervez Sultan, Justin Kua, James E O'Carroll

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引用次数: 0

摘要

背景：轴向麻醉是剖宫产的金标准技术，然而剖宫产过程中的疼痛可能被低估。本系统综述和荟萃分析的主要目的是确定神经轴麻醉下剖宫产术中疼痛的发生率。方法：检索PubMed MEDLINE、Embase、Web of Science、Scopus、Cochrane Database of Systematic Reviews、Central Register of Controlled Trials等数据库的文献。搜索主题包括有关剖宫产、神经轴麻醉、疼痛和发生率的术语。进行荟萃分析以计算患者报告的疼痛发生率以及麻醉方式如何影响患者报告的疼痛发生率，并对纳入的论文进行偏倚风险评估。结果：共筛选到2061篇摘要；纳入34篇文献（21篇随机研究，13篇非随机研究）。轴向麻醉下术中疼痛的粗发生率为10.8%（11351例患者中有1229例），合并发生率为17% (95%CI: 13% - 22%；11351名患者中的1229名)。接受脊髓麻醉的患者总疼痛发生率最低，为14% (95%CI: 10.0% - 20.0%；8,002例患者中有662例)和接受硬膜外充血的患者的总疼痛发生率最高，为33% (95%CI: 17.0% - 54.0%；1395名患者中有253名)。偏倚风险评估显示，纳入的研究中有一半存在高偏倚风险。结论：神经轴麻醉下剖宫产患者报告疼痛是常见的，脊髓和脊髓-硬膜外联合麻醉报告的疼痛发生率低于硬膜外麻醉。术中疼痛对患者有重大的心理影响，对提供者也有医学法律意义。需要进一步的前瞻性研究来描述和理解患者疼痛经历的影响，并开发技术来减少这种并发症。

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Intraoperative pain during cesarean delivery under neuraxial anesthesia: A systematic review and meta-analysis.

Background: Neuraxial anesthesia is the gold standard technique for cesarean delivery, however pain during cesarean delivery may be underreported. The primary aim of this systematic review and meta-analysis was to determine the incidence of patient reported intraoperative pain during cesarean delivery under neuraxial anesthesia.

Methods: A literature search of databases (PubMed MEDLINE, Embase, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials) was conducted. Search topics included terminology concerning cesarean delivery, neuraxial anesthesia, pain, and incidence. Meta-analyses were performed to calculate pooled incidences of patient reported pain and how mode of anesthesia influenced the incidence of patient reported pain, with included papers assessed for risk of bias.

Results: A total of 2061 abstracts were screened; 34 articles were included (21 randomized studies and 13 non-randomized studies). The crude incidence of intraoperative pain under neuraxial anesthesia was 10.8% (1,229 out of 11,351 patients) and the pooled incidence was 17% (95%CI: 13% - 22%; 1,229 out of 11,351 patients). Patients who received spinal anesthesia had the lowest pooled incidence of pain of 14% (95%CI: 10.0% - 20.0%; 662 out of 8,002 patients) and those who received epidural top-up had the highest pooled incidence of pain of 33% (95%CI: 17.0% - 54.0%; 253 out of 1,395 patients). Risk of bias assessments showed high risk of bias in half of the included studies.

Conclusions: Patient reported pain during cesarean delivery under neuraxial anesthesia is common, with spinal and combined spinal-epidural anesthesia reporting a lower incidence of pain than epidural anesthesia. Intraoperative pain can have significant psychological impact for patients and medicolegal implications for providers. Further prospective studies are required to characterize and understand the impact of patient experiences of pain and develop techniques to reduce this complication.

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.