摘要
背景：区域麻醉作为心脏手术术后疼痛管理的多模式镇痛的一部分得到广泛支持。治疗胸骨切开术后疼痛的常用技术是胸骨旁肋间平面（PIP）阻滞，即在胸骨附近的筋膜平面注射麻醉剂，阻滞 T2 - T6 神经的前皮支：本研究旨在评估 PIP 阻滞对成人心脏手术后胸骨切开术后疼痛、麻醉剂使用、重症监护室（ICU）停留时间和拔管时间的影响：我们对研究成人心脏手术胸骨中线切开术中 PIP 阻滞的随机对照试验 (RCT) 进行了系统回顾和荟萃分析。截至 2023 年 2 月 22 日，我们从 PubMed、Cochrane Library 和 Embase 上检索了相关研究。使用 Cochrane ROB 工具（第 2 版）评估了 RCT 的偏倚风险 (ROB)。共纳入了 12 项 RCT，涉及 819 名成年患者。主要研究结果为术后12小时和24小时的疼痛评分以及以吗啡毫克当量（MME）为单位的麻醉剂用量。次要结果包括拔管时间和重症监护室住院时间：PIP 阻滞组在 12 小时（平均差 [MD]：-1.21 分，95% 置信区间 [CI]：-2.17，-0.25，p = 0.013）和 24 小时（MD：-0.69 分，95% 置信区间 [CI]：-1.35，-0.02，p = 0.042）的疼痛评分明显降低，吗啡毫克当量（MME）用量减少（MD：-30.34 MME，95% 置信区间 [CI]：-45.80，-14.89，p < 0.001）。PIP阻滞并未明显缩短拔管时间（MD：-0.77 h，95% CI：-1.64，0.09，p = 0.080），但与ICU住院时间缩短有关（MD：-0.54天，95% CI：-0.94，-0.13，p = 0.009）：PIP阻滞可为需要进行胸骨切开术的心脏手术患者提供有效的镇痛并缩短ICU住院时间，但由于研究的异质性，对结果的解释应谨慎。今后的研究应探讨其短期和长期效果。Background: Regional anesthesia is widely supported as a part of multimodal analgesia for post-operative pain management following cardiac surgery. A common technique for managing post-sternotomy pain is the parasternal intercostal plane (PIP) block, which involves injecting anesthetics into the fascial planes near the sternum to block the anterior cutaneous branches of the T2 - T6 nerves.
Objective: This study aimed to assess the effects of PIP blocks on post-sternotomy pain, narcotic usage, intensive care unit (ICU) stay, and extubation time following adult cardiac surgeries.
Methodology: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating PIP blocks in adult cardiac surgery with midline sternotomy. Studies were retrieved from PubMed, Cochrane Library, and Embase through February 22, 2023. The risk of bias (ROB) in RCTs was assessed using the Cochrane ROB tool, version 2. Twelve RCTs involving 819 adult patients were included. Primary outcomes were pain scores at 12 and 24 h post-surgery and narcotic usage in morphine milligram equivalents (MME). Secondary outcomes included extubation time and ICU stay.
Results: The PIP block group had significantly lower pain scores at 12 (mean difference [MD]: -1.21 points, 95% confidence interval [CI]: -2.17, -0.25, p = 0.013) and 24 hours (MD: -0.69 points, 95% CI: -1.35, -0.02, p = 0.042), and reduced MME use (MD: -30.34 MME, 95% CI: -45.80, -14.89, p < 0.001). PIP blocks did not significantly reduce extubation time (MD: -0.77 h, 95% CI: -1.64, 0.09, p = 0.080) but were associated with shorter ICU stay (MD: -0.54 days, 95% CI: -0.94, -0.13, p = 0.009).
Conclusion: PIP blocks provided effective analgesia and reduced ICU stay in cardiac surgery patients requiring sternotomy, but due to study heterogeneity, results should be interpreted with caution. Future research is warranted to explore its short- and long-term outcomes.
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