单次竖脊肌平面阻滞降低胸腔镜术后阿片类药物消耗和恶心呕吐的系统评价与meta分析

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Abstract Objective To evaluate the effect of erector spinae plane block (ESPB) in reducing opioid consumption and nausea and vomiting after thoracoscopic surgery.Methods In accordance with the retrieval strategies,two independent researchers conducted a series of studies in China Biomedical Literature Database,CNKI,Wanfang Database,VIP Database,PubMed,Web of Science,Embase and Cochrane randomized controlled trials (RCT) comparing general anesthesia combined with ESPB (ESPB group) and general anesthesia alone without block (control group) for thoracoscopic surgical analgesia were searched from Library Chinese and English database until January 1,2022.Outcomes included:①Incidence of postoperative nausea and vomiting;②The amount of postoperative opioid analgesics;③Pain scores at each time after surgery.Meta-analysis was performed using RevMan 5.4 and Stata 16.0 software.Results A total of 16 RCTs were included,including 1148 patients.There was no significant difference in the incidence of postoperative nausea and vomiting (PONV) 24 h after surgery between the ESPB group and the control group (relative risk [RR]=0.62,95%confidence interval [CI]=0.37-1.02,P=0.06).The incidence of postoperative PONV in the ESPB group was lower than that in the control group,and the difference was statistically significant (RR=0.47,95%CI=0.34-0.66,P＜0.001).The postoperative resting pain score and postoperative cough or exercise pain score in the ESPB group were lower than those in the control group,and the differences were statistically significant (P ＜0.05).The use of opioids in ESPB group was lower than that in the control group at 24 h postoperatively,the difference was statistically significant (mean difference [MD]=-17.48,95%CI=-18.66 to -16.30,P＜0.000 01),and the use of opioids at 48 h postoperatively was lower than that in the control group,the difference was statistically significant (MD=-17.31,95%CI=-19.72 to -14.89,P＜0.000 01).Conclusion The erector spinae plane block reduced pain scores and the incidence of postoperative nausea and vomiting in thoracoscopic patients 48 h after surgery,and significantly reduced the use of postoperative opioids in patients.

Key words： Erector spinae plane block Thoracoscopic Postoperative nausea and vomiting Meta-analysis

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