乳腺手术患者胸椎旁神经阻滞与胸神经阻滞效果比较的Meta分析

Thoracic paravertebral block versus pectoral nerve block for breast surgery: a meta-analysis

摘要:

目的 采用系统评价和Meta分析方法比较乳腺手术患者行胸椎旁神经阻滞（TPVB）和胸神经阻滞（Pecs阻滞）的镇痛效果。方法 检索PubMed、Web of Science、Embase、Ovid、Cochrane图书馆、CNKI、维普数据库、万方数据库和中国生物医学全文数据库，收集比较TPVB和PECS阻滞在乳腺手术麻醉镇痛效果的随机对照试验（RCT）。应用RevMan 5.2软件进行统计学分析。结果 获得符合标准的6个RCT研究，共计323例，其中PECS阻滞组161例，TPVB组162例。Meta分析结果显示：PECS阻滞组术后镇痛药物使用量少于TPVB组[MD=1.350，95% CI（-2.240，-0.460）]，TPVB组术后疼痛评分高于PECS阻滞组[MD=1.350，95% CI（-2.110，-0.590）]，两组术后恶心呕吐发生率差异无统计学意义[RlR=0.930，95% CI（0.560，1.320）]。结论 现有证据表明对于乳腺手术患者，PECS阻滞镇痛效果优于TPVB镇痛。

Abstract:

Objective To explore the effect of thoracic paravertebral block (TPVB) and pectoral nerve block (PECS block) on patients underwent breast surgery. Methods Public databases were searched including PubMed, Web of Science, EMBase, Ovid, Cochrane, CNKI, VIP and wanfang Data and CMB, in order to collect randomized controlled trial (RCT) of the effects of TPVB and PECS block on breast surgery. RevMan 5.2 software was used to carry out the Meta-analysis. Results There were six RCTs consisting of 323 patients underwent breast surgery in group PECS block (n?=?161) and group TPVB (n?=?162). Mata-analysis showed that the postoperative analgesic consumption of group PECS block was lower than that of group TPVB [MD?=?1.35, 95% CI (-2.24, -0.46)]. The pain scores of group TPVB was higher than that of the group PECS block [MD?=?1.35, 95% CI (-2.11, -0.59)]. There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups [RlR?=?0.93, 95% CI (0.56, 1.32)]. Conclusions According to existing evidence, PECS block analgesia is superior to TPVB block analgesia in breast surgery patients.