医学
不利影响
麻醉
神经阻滞
荟萃分析
置信区间
随机对照试验
块(置换群论)
严格标准化平均差
外科
乳房外科
内科学
乳腺癌
几何学
数学
癌症
作者
Michael Meißner,Ece Austenfeld,Peter Kranke,Peter Zahn,Esther Pogatzki‐Zahn,Christine H. Meyer‐Frießem,Stephanie Weibel,Alexander Schnabel
标识
DOI:10.1097/eja.0000000000001403
摘要
Pectoral nerve blocks (PECS block) might be an interesting new regional anaesthetic technique in patients undergoing breast surgery.The aim of this meta-analysis was to investigate postoperative pain outcomes and adverse events of a PECS block compared with no treatment, sham treatment or other regional anaesthetic techniques in women undergoing breast surgery.We performed a systematic review of randomised controlled trials (RCT) with meta-analysis and risk of bias assessment.The databases MEDLINE, CENTRAL (until December 2019) and clinicaltrials.gov were systematically searched.All RCTs investigating the efficacy and adverse events of PECS compared with sham treatment, no treatment or other regional anaesthetic techniques in women undergoing breast surgery with general anaesthesia were included.A total of 24 RCTs (1565 patients) were included. PECS (compared with no treatment) block might reduce pain at rest [mean difference -1.14, 95% confidence interval (CI), -2.1 to -0.18, moderate quality evidence] but we are uncertain regarding the effect on pain during movement at 24 h after surgery (mean difference -1.79, 95% CI, -3.5 to -0.08, very low-quality evidence). We are also uncertain about the effect of PECS block on pain at rest at 24 h compared with sham block (mean difference -0.83, 95% CI, -1.80 to 0.14) or compared with paravertebral block (PVB) (mean difference -0.18, 95% CI, -1.0 to 0.65), both with very low-quality evidence. PECS block may have no effect on pain on movement at 24 h after surgery compared with PVB block (mean difference -0.56, 95% CI, -1.53 to 0.41, low-quality evidence). Block-related complications were generally poorly reported.There is moderate quality evidence that PECS block compared with no treatment reduces postoperative pain intensity at rest. The observed results were less pronounced if patients received a sham block. Furthermore, PECS blocks might be equally effective as PVBs. Due to mostly low-quality or very low-quality evidence level, further research is warranted.CRD42019126733.
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