文献类型：期刊文献

中文题名：髋关节囊周围神经阻滞对全髋关节置换患者围术期镇痛疗效的meta分析

英文题名：Meta-analysis of the effect of peri-capsular nerve block on perioperative analgesia in patients with total hip arthroplast

作者：丁声双[1];张杰[1];黄伟华[1];秦晓宇[1];段蓉蓉[1];逯晓婷[1];薛建军[2]

第一作者：丁声双

机构：[1]甘肃中医药大学第一临床医学院,兰州730000;[2]甘肃省中医院麻醉科,兰州730050

第一机构：甘肃中医药大学临床医学院

年份：2023

卷号：52

期号：7

起止页码：1052

中文期刊名：重庆医学

外文期刊名：Chongqing medicine

收录：CSTPCD;;PubMed

基金：甘肃省科技计划资助项目-临床医学研究中心建设(20JR10RA435)。

语种：中文

中文关键词：全髋关节置换;髋关节囊周神经阻滞;随机对照试验;meta分析;围手术期;镇痛

外文关键词：total hip arthroplasty;pericapsular nerve block;randomized controlled trial;meta analysis;perioperative period;analgesia

摘要：目的运用meta分析综合评价髋关节囊周围神经阻滞(PENGB)对全髋关节置换术(THA)患者围术期的镇痛疗效。方法运用计算机检索The Cochrane Library、PubMed、Web of Science、EMbase、维普(VIP)、中国知网(CNKI)、万方数据知识服务平台(WanFang Date)和中国生物医学文献数据库(CBM)等数据库发表的关于PENGB用于THA患者围术期镇痛的随机对照试验,检索时间从建库至2022年2月25日,运用RevMan5.3软件对最终符合要求的文章进行meta分析。结果本次meta分析共纳入7篇文献,共419例患者。meta分析结果显示,与对照组比较,PENGB组神经阻滞后10 min[MD=-1.76,95%CI(-3.40,-0.12),P=0.04]、20 min[MD=-1.55,95%CI(-2.60,-0.50),P<0.05]、30 min[MD=-1.40,95%CI(-2.18,-0.63),P<0.05]的疼痛评分及摆放侧卧位即刻的疼痛评分[MD=-1.28,95%CI(-2.31,-0.24),P=0.02]降低;但PENGB组与对照组术后6、12、24 h疼痛评分,术后12、24、28 h阿片类药物用量比较,差异无统计学意义(P>0.05)。PENGB组与对照组术后恶心呕吐(PONV)发生率比较,差异也无统计学意义(P>0.05)。与对照组比较,PENGB组股四头肌肌无力发生率降低[RR=0.10,95%CI(0.02,0.53),P<0.05]。PENGB组与对照组患者镇痛满意度比较,差异无统计学意义(P>0.05)。结论目前的证据显示,虽然PENGB和其他神经阻滞在术后镇痛效果和PONV控制效果方面的差异不显著,但其在神经阻滞后10、20、30 min及摆放侧卧位即刻有更好的镇痛效果,并且PENGB在保留患者股四头肌肌力方面可能也更具优势,但还需后续更多研究进一步验证。
Objective To use meta-analysis to comprehensively evaluate the analgesic effect of peri-capsular nerve block(PENGB)on patients undergoing total hip arthroplasty(THA).Methods The randomized controlled trial of PENGB for perioperative analgesia of THA patients published in the Cochrane Library,PubMed,Web of Science,EMbase,VIP,CNKI,Wanfang Date and China Biomedical Literature Database(CBM).The search time was from the establishment of the database to February 25,2022.Meta-analysis was conducted on the articles that finally met the requirements by RevMan5.3 software.Results A total of 7 articles which contained 419 patients were finally included in this meta-analysis.Meta-analysis results showed that,compared with the control group(other nerve block methods),the pain scores of the PENGB group at 10 min[MD=-1.76,95%CI(-3.40,-0.12),P=0.04],20 min[MD=-1.55,95%CI(-2.60,-0.50),P<0.05],30 min[MD=-1.40,95%CI(-2.18,-0.63),P<0.05]after nerve block and the immediately after placing in the lateral position[MD=-1.28,95%CI(-2.31,-0.24),P=0.02]decreased.However,there was no statistically significant difference in the pain score at 6,12 and 24 hours after operation and the amount of opioid drugs used at 12,24 and 48 hours after operation between the PENGB group and the control group(P>0.05).There was no significant difference in the incidence of postoperative nausea and vomiting(PONV)between the PENGB group and the control group,neither(P>0.05).Compared with the control group,the incidence of quadriceps femoris muscle weakness decreased in the PENGB group[RR=0.10,95%CI(0.02,0.53),P<0.05].There was no statistically significant difference in pain relief satisfaction between the PENGB group and the control group(P>0.05).Conclusion The current evidence shows that although PENGB and other nerve blocks have no significant difference in postoperative analgesia effect and PONV control effect,it has better analgesic effect at 10,20,30 minutes after nerve block and immediately after placing in the lateral position,and PENGB may also have more advantages in preserving the quadriceps muscle strength of patients,but more follow-up studies are needed to further verify.