竖脊肌平面阻滞对腰椎手术的抗痛觉和镇痛有用吗?对文献和观点论文的叙述性评论

IF 0.1 Q4 ANESTHESIOLOGY
G. Tran, N. Vyncke, J. Montupil, V. Bonhomme, A. Defresne
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引用次数: 1

摘要

我们的目的是确定直立棘平面(ESP)阻滞是否有助于为腰椎手术后受益的患者提供抗伤害和镇痛。使用Pubmed、Cochrane图书馆数据库和谷歌学者(2021年3月搜索结束)中的关键词“勃起-脊柱平面阻滞”和“腰椎”或“脊柱手术”,我们确定了19篇相关论文,涉及534名患者。不同研究的局部麻醉剂溶液的注射水平、类型、稀释度或体积不同。主要研究结果是术后疼痛控制和阿片类药物消耗。只有一项研究将ESP块与另一种局部区域技术进行了比较。所有已发表的论文都得出结论,ESP阻滞可以降低术后疼痛评分和挽救药物使用。作为一个推论,ESP块在这一指示中似乎很有前景,原因有几个。首先,它很容易执行,并且没有与神经轴技术相同的不良影响或并发症。其次,即使尚未确定最佳注射部位,也可以在距离手术部位较远的地方进行皮肤穿刺,从而通过局部区域技术降低手术部位感染的风险,并允许将其用作手术后的抢救性镇痛技术。最后,ESP阻滞并发症的发生率似乎很低,即使研究的患者数量不足以确定这一事实。几个悬而未决的问题仍然悬而未决。没有一项已发表的研究是随机对照试验,其中一组接受假阻滞,随访时间限制在48小时内,慢性疼痛是一个排除标准,疼痛评分在休息时进行评估。我们得出结论,ESP阻滞似乎是一种安全且有前景的技术,可作为腰椎手术多模式镇痛方案的一部分。需要进行几项研究来确定其与其他技术相比的优越性和安全性、术中阿片类药物的保留效果以及对长期结果(如慢性疼痛的发展)的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is the Erector Spinae Plane block useful for anti-nociception and analgesia in lumbar spine surgery? A narrative review of the literature and opinion paper
We aimed at determining whether the Erector Spinae Plane (ESP) block is useful for providing anti-nociception and analgesia to patients beneficiating from lumbar spine surgery. Using the keywords “Erector Spinae Plane block” and “lumbar” or “spinal surgery” in Pubmed, the Cochrane Library Database, and Google Scholar (end of search in March 2021), we identified 19 relevant papers involving 534 patients. Injection levels, and type, dilution, or volume of local anesthetic agent solution differed between studies. The main studied outcomes were postoperative pain control, and opioid consumption. Only one study compared the ESP block with another loco- regional technique. All published papers conclude that ESP block reduces postoperative pain scores and rescue medication use. As a corollary, ESP block appears promising in this indication for several reasons. First, it is easy to perform and does not have the same adverse effects or complications as neuraxial techniques. Second, even if the best site of injection as not been determined yet, skin puncture can be performed at distance from the surgical site, hence reducing the risk of surgical site infection by the loco-regional technique, and allowing its use as a rescue analgesic technique after surgery. Last, the incidence of ESP block complications seems low even if the number of studied patients is not wide enough to ascertain this fact for sure. Several unresolved questions are still pending. None of the published studies were randomized controlled trials with a group receiving a sham block, length of follow-up was limited to 48 hours, chronic pain was an exclusion criteria, and the pain scores were evaluated at rest. We conclude that the ESP block appears to be a safe and promising technique to be used as part of a multimodal analgesia protocol in lumbar spine surgery. Several studies are needed to precise its superiority and safety as compared to other techniques, its intraoperative opioid sparing effect, and its influence on longer term outcomes such as the development of chronic pain.
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来源期刊
CiteScore
0.20
自引率
0.00%
发文量
2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
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