Frontiers in medicine · 2025
Analgesic efficacy of erector spinae plane block for managing pain in arthroscopic shoulder surgery: a systemic review and meta-analysis.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Ying, Yang Qiuya, Jie Wen, Liu Yan, Jiang Fenglin
Аннотация
BACKGROUND: Whether the erector spinae plane block (ESPB) truly relieves pain after arthroscopic shoulder surgery (ASS) is still unsettled. We therefore examined whether ESPB sharpens post-operative pain control in these patients.
METHODS: We systematically searched the Cochrane Library, PubMed, Embase, and Web of Science for randomized controlled trials (RCTs) comparing ESPB with any comparator (no block, sham block, or alternative regional block) in patients undergoing ASS. The primary outcome was cumulative opioid consumption within the first 24 h postoperatively. Secondary outcomes included pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), time to first rescue analgesic request, and patient-reported satisfaction with analgesia.
RESULTS: Six RCTs comprised of 365 patients met inclusion criteria. ESPB did not reduce 24-h opioid consumption versus control (SMD -1.11; 95% CI -2.55 to 0.33; p = 0.13, I 2 = 96%). Pain scores were lower with ESPB at 2 h (SMD -0.83; 95% CI -1.30 to -0.37; p = 0.0005, I 2 = 35%) and 48 h (SMD -0.64; 95% CI -1.08 to -0.20; p = 0.004, I 2 = 95%), but not at 4 h. Furthermore, time to first rescue analgesic was prolonged by ESPB (SMD 4.04; 95% CI 0.77-7.31; p = 0.02, I 2 = 99%). However, ESPB did not reduce the rest and movement pain scores at 2 h (SMD -0.87; 95% CI -2.98 to 1.24; p = 0.42; I 2 = 97%; SMD -0.98; 95% CI -3.00 to 1.04; p = 0.34; I 2 = 97%) and 4 h (SMD -0.43; 95% CI -2.31 to 1.46; p = 0.66; I 2 = 97%; SMD -0.89; 95% CI -2.57 to 0.80; p = 0.30; I 2 = 96%), respectively. PONV and other adverse events were comparable. Subgroup analysis of single-injection ESPB also showed no opioid-sparing effect (SMD -1.46; 95% CI -3.21 to 0.30; p = 0.10, I 2 = 97%). Patient-reported satisfaction revealed no significant difference between ESPB and control group.
CONCLUSION: The ESPB fails to reduce 24-h opioid consumption, pain scores at rest and movement at early stage, and the incidence of PONV. Nevertheless, it prolonged the time to first rescue analgesic without elevating the risk of adverse events.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO, registration number CRD 42023395027, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395027.
METHODS: We systematically searched the Cochrane Library, PubMed, Embase, and Web of Science for randomized controlled trials (RCTs) comparing ESPB with any comparator (no block, sham block, or alternative regional block) in patients undergoing ASS. The primary outcome was cumulative opioid consumption within the first 24 h postoperatively. Secondary outcomes included pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), time to first rescue analgesic request, and patient-reported satisfaction with analgesia.
RESULTS: Six RCTs comprised of 365 patients met inclusion criteria. ESPB did not reduce 24-h opioid consumption versus control (SMD -1.11; 95% CI -2.55 to 0.33; p = 0.13, I 2 = 96%). Pain scores were lower with ESPB at 2 h (SMD -0.83; 95% CI -1.30 to -0.37; p = 0.0005, I 2 = 35%) and 48 h (SMD -0.64; 95% CI -1.08 to -0.20; p = 0.004, I 2 = 95%), but not at 4 h. Furthermore, time to first rescue analgesic was prolonged by ESPB (SMD 4.04; 95% CI 0.77-7.31; p = 0.02, I 2 = 99%). However, ESPB did not reduce the rest and movement pain scores at 2 h (SMD -0.87; 95% CI -2.98 to 1.24; p = 0.42; I 2 = 97%; SMD -0.98; 95% CI -3.00 to 1.04; p = 0.34; I 2 = 97%) and 4 h (SMD -0.43; 95% CI -2.31 to 1.46; p = 0.66; I 2 = 97%; SMD -0.89; 95% CI -2.57 to 0.80; p = 0.30; I 2 = 96%), respectively. PONV and other adverse events were comparable. Subgroup analysis of single-injection ESPB also showed no opioid-sparing effect (SMD -1.46; 95% CI -3.21 to 0.30; p = 0.10, I 2 = 97%). Patient-reported satisfaction revealed no significant difference between ESPB and control group.
CONCLUSION: The ESPB fails to reduce 24-h opioid consumption, pain scores at rest and movement at early stage, and the incidence of PONV. Nevertheless, it prolonged the time to first rescue analgesic without elevating the risk of adverse events.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO, registration number CRD 42023395027, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395027.