周围神经阻滞治疗肋骨骨折患者疼痛的疗效观察：一项系统性回顾和meta分析

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周围神经阻滞治疗肋骨骨折患者疼痛的疗效观察：一项系统性回顾和meta分析

贵州医科大学  麻醉学与心脏电生理课题组

翻译：邓举

编辑：宋雨婷

审校：曹莹

目的

本研究的目的是评估不同的周围神经阻滞与传统方法（镇痛药和硬膜外阻滞）对缓解肋骨骨折患者疼痛的疗效。

方法

系统检索了PubMed、Embase、Scopus和Cochrane 临床对照试验中心注册数据库。该研究包括了随机对照试验（RCTs）或倾向得分匹配的观察性研究。主要结局指标为患者休息时和咳嗽/运动时的疼痛评分。次要结局指标为住院时间、重症监护病房（ICU）滞留时间、补救性镇痛药的使用情况、动脉血气和肺功能检测指标。采用STATA进行统计学分析。

结果

该研究共纳入12项研究。与传统方法相比，周围神经阻滞在术后12小时（SMD -4.89，95% CI：-5.91，-3.86）和24小时（SMD -2.58，95% CI：-4.40，-0.76）能较好地缓解疼痛。综合研究结果显示，在阻滞后24小时，周围神经阻滞组在运动/咳嗽时有更好的疼痛管理（SMD -0.78,95% CI：-1.48，-0.09）。患者休息时和阻滞后24小时的运动/咳嗽疼痛评分无显著差异。两组患者发生并发症（RR 0.48、95% CI：0.20、1.18）、肺部并发症（RR 0.71、95% CI：0.35、1.41）和住院死亡率（RR 0.62、95% CI：0.20、1.90）的总体风险均无差异。周围神经阻滞组减少了补救性镇痛药的使用（SMD -0.31,95% CI：-0.54，-0.07）。两种疼痛管理方式在ICU滞留时间、住院时间、并发症风险、动脉血气或肺功能，即PaO2和用力肺活量方面均无差异。

结论

对于肋骨骨折的患者，周围神经阻滞可能比常规的疼痛管理方式更能及时地缓解疼痛（在疼痛阻滞开始后24小时内），这种方法也减少了对补救性镇痛药的使用。在临床工作中，应从医生的技术和经验、现有的护理设施以及所涉及的费用方面决定使用哪种疼痛管理策略。

原始文献来源：

D.-L. XIAO, J.-W. XI.Efficacy of peripheral nerve blocks for pain management in patients with rib fractures: A systematic review and meta-analysis［J］.European Review for Medical and Pharmacological Sciences 2023; 27: 899-910.

英文原文

Efficacy of peripheral nerve blocks for painmanagement in patients with rib fractures:

A systematic review and meta-analysis

Objective: 

The aim of the study was to assess the efficacy of different peripheral nerve blocks, compared to conventional methods (analgesics and epidural block), for pain relief in rib fracture patients.

Materials and Methods: 

PubMed, Embase, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched. The review included studies that were either randomized controlled trials (RCTs) or observational in design with propensity matching. The primary outcome of interest was patient’s reported pain scores, both at rest and on coughing/movement. The secondary outcomes were length of hospital stay, length of stay at intensive care unit (ICU), need for rescue analgesic, arterial blood gas values and parameters of lung function test. STATA was used for statistical analysis. 

Results: 

The meta-analysis was conducted with 12 studies. Compared to conventional methods, peripheral nerve block was associated with better pain control at rest 12 hours (SMD -4.89, 95% CI: -5.91, -3.86) and 24 hours (SMD -2.58, 95% CI: -4.40, -0.76) after institution of block. At 24 hours after block, the pooled findings indicate better pain control on movement/ coughing for the peripheral nerve block group (SMD -0.78, 95% CI: -1.48, -0.09). There were no significant differences in the patient’s reported pain scores at rest and on movement/coughing at 24 hours post-block. There were no differences in the overall risk of any complications (RR 0.48, 95% CI: 0.20, 1.18), pulmonary complication (RR 0.71, 95% CI: 0.35, 1.41) and in-hospital mortality (RR 0.62, 95% CI: 0.20, 1.90) between the two groups. Peripheral nerve block was also associated with a relatively lower need for rescue analgesic (SMD -0.31, 95% CI: -0.54, -0.07). There were no differences in the length of ICU and hospital stay, risk of complications, arterial blood gas values or functional lung parameters, i.e., PaO2 and forced vital capacity between the two management strategies.

Conclusions: 

Peripheral nerve blocks maybe better than conventional pain management strategies for immediate pain control (within 24 hours of initiation of block) in patients with fractured ribs. This method also reduces the need for rescue analgesic. The skills and experience of the health personnel, facilities for care available and the cost involved should guide the decision on which management strategy to utilize.

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编辑：Michel.米萱

校对：MiLu.米鹭