竖脊肌平面阻滞在减重手术中的应用：随机对照试验的系统评价与荟萃分析及试验序贯分析。
摘要
背景：据报道，使用竖脊肌平面（ESP）阻滞可减少接受减重与代谢手术（BMS）患者的阿片类药物需求量。我们旨在系统评价并检验ESP阻滞用于BMS的证据。方法：检索MEDLINE、Embase、Scopus和CENTRAL电子数据库中自建库至2025年7月21日关于ESP阻滞用于BMS的所有研究。两名评价者独立评估并筛选研究、收集数据、评估偏倚风险和证据质量。…
正文 待译
BACKGROUND: The use of erector spinae plane (ESP) block has been reported to decrease opioid requirements for patients undergoing bariatric and metabolic surgeries (BMS). We aim to systematically review and examine the evidence for the use of ESP block in BMS. METHODS: MEDLINE, Embase, Scopus, and CENTRAL electronic databases were searched for all studies on ESP block in BMS from database inception through 21st July 2025. Two reviewers independently assessed and selected studies, collected data, assessed the risk of bias and quality of evidence. The primary outcome for this review is opioid consumption in 24 h post-operation. Secondary outcomes include intraoperative opioid consumption, time to first request for analgesia, and postoperative pain scores. RESULTS: Nine randomised control trials involving 613 patients were found to be eligible. ESP block significantly reduced opioid consumption in the first 24 h after surgery, with a mean oral morphine equivalent daily dose (oMMED) reduction of 36.94 mg (95% CI -60.85 to -13.03, p = 0.009, I2 = 94%). Trial sequential analysis (TSA) suggests a potential benefit of ESP block though this interpretation is limited by marked statistical heterogeneity. Time to first request for analgesia was significantly prolonged with ESP block. Intraoperative opioid requirements, time to first request for analgesia, and postoperative reported pain scores were reduced in the ESP block group. CONCLUSIONS: Current evidence suggests that the bilateral ultrasound-guided ESP block may be a practical technique to improve perioperative pain control and reduce opioid usage in patients undergoing BMS. However, these findings must be interpreted with caution due to the very low to moderate certainty of evidence and high clinical heterogeneity.
English
BACKGROUND: The use of erector spinae plane (ESP) block has been reported to decrease opioid requirements for patients undergoing bariatric and metabolic surgeries (BMS). We aim to systematically review and examine the evidence for the use of ESP block in BMS. METHODS: MEDLINE, Embase, Scopus, and CENTRAL electronic databases were searched for all studies on ESP block in BMS from database inception through 21st July 2025. Two reviewers independently assessed and selected studies, collected data, assessed the risk of bias and quality of evidence.…