竖脊肌平面阻滞对冠状动脉旁路移植术后镇痛及住院恢复的影响：一项包含荟萃分析、荟萃回归和序贯试验分析的系统评价。
完整摘要 · 中文译文
竖脊肌平面阻滞（ESPB）是一种有前景的心脏手术区域麻醉技术。我们评估了ESPB在冠状动脉旁路移植术（CABG）患者中的镇痛效果及院内结局。我们进行了一项系统评价和荟萃分析，比较ESPB与对照组在成年CABG患者中的应用（CRD42025645045）。主要结局指标为阿片类药物消耗量（24小时/48小时）和疼痛强度。次要结局指标包括拔管时间和重症监护病房（ICU）住院时长。数据采用随机效应模型进行合并。使用荟萃回归和试验序贯分析（TSA）分别评估异质性来源和结果稳健性，同时采用推荐分级评估、制定与评价（GRADE）框架为每个结局提供证据确定性。共分析了12项研究（704例患者）。ESPB显著降低了24小时吗啡毫克当量消耗量（平均差（MD）-19.05 mg；95%置信区间（CI）[-22.50至-15.61]；P < 0.001；高确定性）和48小时吗啡毫克当量消耗量（MD -19.42 mg；95% CI [-28.75至-10.09]；P < 0.001；中等确定性）。采用数字评定量表评估的疼痛评分在12小时内（MD -0.93；P < 0.001；中等确定性）和24小时（MD -0.58；P = 0.016；低确定性）均较低。ESPB缩短了拔管时间（MD -2.50小时；高确定性）和ICU住院时长（MD -12.55小时；中等确定性）。TSA确认了关于阿片类药物减少、早期疼痛缓解和拔管获益的稳健证据。ESPB可提供有效的早期镇痛，减少围手术期阿片类药物需求。 这些措施可促进冠状动脉旁路移植术（CABG）后的恢复，是对传统单纯静脉镇痛的实质性补充。未来研究应探讨持续性的技术手段。
完整摘要 · 英文原文
The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed. ESPB significantly reduced the morphine milligram equivalent consumption at 24 h (mean difference (MD) -19.05 mg; 95% confidence interval (CI) [-22.50 to -15.61]; P < 0.001; high certainty) and 48 h (MD -19.42 mg; 95% CI [-28.75 to -10.09]; P < 0.001; moderate certainty). Pain scores, by the Numerical Rating Scale, were lower within 12 h (MD -0.93; P < 0.001; moderate certainty) and at 24 h (MD -0.58; P = 0.016; low certainty). ESPB shortened extubation time (MD -2.50 h; high certainty) and ICU stay (MD -12.55 h; moderate certainty). TSA confirmed robust evidence for opioid reduction, early pain relief, and extubation benefits. ESPB provides effective early analgesia, reduces perioperative opioid requirements, and accelerates recovery in CABG, representing a fundamental complement to conventional isolated intravenous analgesia. Future research should investigate continuous techniques.