胸筋膜平面阻滞术对阿片类药物的节约效应：一项随机对照试验的meta分析
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Opioid‑sparing effects of the thoracic interfascial plane blocks:A meta‑analysis of randomized controlled trials
背景与目的
胸筋膜平面阻滞和修饰术（PECS）近来在乳腺手术中的镇痛潜力获得了普及。与常规静脉镇痛（IVA）和椎旁阻滞（PVB）相比，我们收集并评估了PECS阻滞术对阿片类药物节约效应的相关证据。
方 法
在医学数据库中检索了2017年6月前发表的接受乳腺手术的患者中采用PECS阻滞术与常规IVA或PVB的前瞻性随机对照试验。对比术后24小时吗啡使用量和术中芬太尼使用量。
结 果
最终分析包括九项试验（PECS vs. IVA 4项试验和PECS vs. PVB 5项试验）。 PECS阻滞组与IVA组相比术中芬太尼使用量减少49.20 mcg（95％置信区间[CI] = 42.67-55.74）（I2 = 98.47％，P <0.001），与PVB组相比减少15.88 mcg（95％CI = 12.95-18.81）（I2 = 95.51％，P <0.001）。术后24小时吗啡使用量PECS阻滞组比IVA组低7.66 mg（95％CI为6.23-9.10）（I2 = 63.15，P <0.001），但比PVB组高1.26mg（95％CI为0.91-1.62）（I2 = 99.53％，P <0.001）。PVB组患者中有2例发生气胸，其他组未见并发症。
结 论
采用PECS阻滞及其修饰术在全麻乳腺手术术中及术后第一个24小时内均具有显著的阿片类药物节约效应。与PVB组相比，它的术中阿片类药物节约效应更高。在术后第1天，PVB组的吗啡节约效应更高，但并发症的发生率也更高。目前的PECS阻滞技术显示出明显的研究间变化并需要标准化。
原始文献摘要
Singh PM, Borle A, Kaur M, Trikha A, Sinha A；Opioid‑sparing effects of the thoracic interfascial plane blocks:A meta‑analysis of randomized controlled trials；Saudi Journal of Anaesthesia [Jan 01，2018, 12(1):103-111]，DOI: 10.4103/sja.SJA_382_17
Background: Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid‑sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB).
Materials and Methods: Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24‑h postoperative morphine consumption and intraoperative fentanyl‑equivalent consumption.
Results: Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67–55.74) (I2 = 98.47%,P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95–18.81) (I2 = 95.51%, P < 0.001). Postoperative, 24‑h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23–9.10) (I2 = 63.15, P < 0.001) but was higher than PVB
group by 1.26 mg (95% CI being 0.91–1.62) (I2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group.
Conclusions: Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid‑sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid‑sparing effect when compared to PVB. During the 1st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization.
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