前锯肌平面阻滞复合全身麻醉与全身麻醉在胸腔镜肺癌手术后镇痛效果对比的Meta分析

Meta-Analysis of Analgesic Effect Comparison between Anterior Serratus Plane Block Combined General Anesthesia and General Anesthesia after Thoracoscopic Lung Cancer Surgery

摘要: 目的：采用Meta分析评估前锯肌平面阻滞(Serratus Plane Block, SPB)复合全身麻醉相较于单纯全身麻醉，在胸腔镜肺癌手术患者术后镇痛效果方面的差异。方法：系统检索PubMed、万方数据库、中国生物医学文献数据库(CBM)、维普中文期刊数据库以及中国知网总库中关于胸腔镜下肺部手术中应用SPB复合全身麻醉与单纯全身麻醉进行镇痛的随机对照试验(RCT)，检索时间为建库起至2024年10月。辅以手工检索相关会议论文集、学位论文等灰色文献，确保纳入研究的全面性。由两位研究人员根据纳入与排除标准筛选文献，进行资料提取；两位研究人员采用Cochrane偏倚风险评估工具评估纳入文献质量，使用RevMa5.4软件进行Meta分析。结果：共纳入了17篇临床随机对照实验(n = 1290)。Meta分析结果显示：两组术后4 h、6 h、8 h、12 h、48 h静息运动状态VAS评分有统计学差异(P < 0.1)，术中丙泊酚用量差异有统计学意义(P < 0.01)，术中舒芬太尼用量、瑞芬太尼用量差异有统计学意义(P = 0.02)。两组术后气管拔管时间有统计学意义(P < 0.01)。两组术后48h镇痛泵按压次数有统计学意义(P = 0.25)。结论：前锯肌平面阻滞复合全身麻醉在胸腔镜肺癌患者手术后能降低术后不同时间段静息运动状态VAS评分，能减少术中丙泊酚，舒芬太尼及瑞芬太尼的使用，降低术后不良反应发生，减少气管插管时间。

Abstract: Objective: To evaluate the difference in postoperative analgesic efficacy between serratus plane block (SPB) combined with general anesthesia and general anesthesia in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer using meta-analysis. Methods: A systematic search was conducted in PubMed, Wanfang Database, Chinese Biomedical Literature Database (CBM), VIP Chinese Journal Database, and China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) comparing SPB combined with general anesthesia versus general anesthesia for analgesia in VATS. The search period was from the establishment of each database to October 2024. Supplementary manual retrieval of gray literature, such as relevant conference proceedings and dissertations, was performed to ensure the comprehensiveness of included studies. Two researchers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the quality of included literatures using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was conducted using RevMan 5.4 software. Results: A total of 17 clinical randomized controlled trials were included (n = 1290). Meta-analysis results showed that there were statistically significant differences in visual analog scale (VAS) scores at rest and during movement at 4 h, 6 h, 8 h, 12 h, and 48 h after surgery between the two groups (P < 0.1). Significant differences were observed in intraoperative propofol dosage (P < 0.01), intraoperative sufentanil dosage, and intraoperative remifentanil dosage (P = 0.02). There was a statistically significant difference in postoperative tracheal extubation time between the two groups (P < 0.01). The difference in the number of presses of analgesic pumps within 48 h after surgery between the two groups was statistically significant (P = 0.25). Conclusion: Serratus plane block combined with general anesthesia can reduce VAS scores at rest and during movement at different postoperative time points, decrease the intraoperative usage of propofol, sufentanil, and remifentanil, reduce the incidence of postoperative adverse reactions, and shorten the tracheal intubation time in patients undergoing VATS for lung cancer.