Data Sheet 2_Analgesic efficacy of erector spinae plane block for managing pain in arthroscopic shoulder surgery: a systemic review and meta-analysis.doc

BackgroundWhether 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.
MethodsWe 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.
ResultsSix 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, I2 = 96%). Pain scores were lower with ESPB at 2 h (SMD −0.83; 95% CI −1.30 to −0.37; p = 0.0005, I2 = 35%) and 48 h (SMD −0.64; 95% CI −1.08 to −0.20; p = 0.004, I2 = 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, I2 = 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; I2 = 97%; SMD −0.98; 95% CI −3.00 to 1.04; p = 0.34; I2 = 97%) and 4 h (SMD −0.43; 95% CI −2.31 to 1.46; p = 0.66; I2 = 97%; SMD −0.89; 95% CI −2.57 to 0.80; p = 0.30; I2 = 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, I2 = 97%). Patient-reported satisfaction revealed no significant difference between ESPB and control group.
ConclusionThe 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 registrationPROSPERO, registration number CRD 42023395027, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395027.

背景
竖脊肌平面阻滞（erector spinae plane block, ESPB）能否真正缓解关节镜肩部手术（arthroscopic shoulder surgery, ASS）后的疼痛，目前尚无定论。因此本研究旨在探讨ESPB是否可改善此类患者的术后疼痛管理。

方法
本研究系统检索了Cochrane图书馆、PubMed、Embase及Web of Science数据库，纳入对比ESPB与任意对照方式（无阻滞、假阻滞或其他区域阻滞）用于接受ASS患者的随机对照试验（randomized controlled trial, RCT）。主要结局指标为术后24小时内阿片类药物累计消耗量；次要结局指标包括静息及活动时的疼痛评分、术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率、首次补救性镇痛请求时间，以及患者报告的镇痛满意度。

结果
共纳入6项RCT，涉及365例患者。与对照组相比，ESPB并未降低术后24小时阿片类药物消耗量（标准化均数差SMD=-1.11；95%置信区间CI：-2.55~0.33；P=0.13，I²=96%）。ESPB组术后2小时（SMD=-0.83；95%CI：-1.30~-0.37；P=0.0005，I²=35%）及48小时（SMD=-0.64；95%CI：-1.08~-0.20；P=0.004，I²=95%）的疼痛评分更低，但术后4小时未见显著差异。此外，ESPB可延长首次补救性镇痛请求时间（SMD=4.04；95%CI：0.77~7.31；P=0.02，I²=99%）。但ESPB并未降低术后2小时及4小时的静息与活动疼痛评分：术后2小时静息疼痛评分（SMD=-0.87；95%CI：-2.98~1.24；P=0.42，I²=97%）、活动疼痛评分（SMD=-0.98；95%CI：-3.00~1.04；P=0.34，I²=97%）；术后4小时静息疼痛评分（SMD=-0.43；95%CI：-2.31~1.46；P=0.66，I²=97%）、活动疼痛评分（SMD=-0.89；95%CI：-2.57~0.80；P=0.30，I²=96%），均无显著差异。PONV及其他不良事件的发生率在两组间无显著差异。单次注射ESPB的亚组分析同样显示其无阿片类药物节省效应（SMD=-1.46；95%CI：-3.21~0.30；P=0.10，I²=97%）。患者报告的镇痛满意度在两组间亦无显著差异。

结论
ESPB未能降低术后24小时阿片类药物消耗量、早期静息及活动时的疼痛评分，亦未降低PONV发生率。但ESPB可延长首次补救性镇痛请求时间，且未增加不良事件发生风险。

系统评价注册
本研究已在PROSPERO注册，注册号为CRD 42023395027，链接：https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395027。