锁骨上神经阻滞与臂丛神经阻滞用于肩部手术的对比：一项临床对照试验的Meta分析
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Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials
背景与目的
超声引导下肌间沟神经阻滞（ISB）一直被认为是肩部术后疼痛管理的标准技术。然而这种方法与膈肌麻痹的发生率息息相关。相对于肌间沟神经阻滞（ISB），锁骨上神经阻滞（SCB）提供低副作用且更为有效的肩部术后镇痛。因此，我们进行了meta分析随机对照试验（RCTs）比较SCB与ISB的有效性和安全性。
方 法
由两名评审员通过PubMed，Wiley在线图书馆，EMBASE和Cochrane图书馆对2017年04月前的文献进行检索。所有可被检索到且符合标准的英文RCTs均被包括在内，两位作者从相关文章中提取数据，用Cochrane手册评估其有效性。并用Review Manager 5.3软件来分析数据。
结 果
五个RCTs和一项前瞻性临床研究符合入选标准并被纳入meta分析。我们认为，锁骨上神经阻滞组与肌间沟神经阻滞组在程序时间（P = 0.81），镇痛（P = 0.53）及呼吸困难上（P = 0.6）无统计学意义。而在声音嘶哑和霍纳综合征的发生率上SCB组比ISB组明显降低（分别为P = 0.0002，P <0.00001）。
结 论
meta分析显示，超声引导的SCB可能成为ISB在肩关节手术中的可行替代技术。
原始文献摘要
Guo CW1, Ma JX2, Ma XL3, Lu B2, Wang Y2, Tian AX2, Sun L2, Wang Y2, Dong BC2, Teng YB2.
Supraclavicular block versus interscalene
brachial plexus block for shoulder surgery: A meta-analysis of clinical control
trials.
Jul 26,2017 ;45:85-91.doi:10.1016/j.ijsu.2017.07.098. [Epub ahead
of print]
BACKGROUND: The ultrasound-guided interscalene
block (ISB) has been considered a standard technique in managing pain after shoulder surgery. However, this method was associated with the incidence of hemidiaphragmatic
paresis. In contrast to ISB, supraclavicular block (SCB) was suggested to provide effective anaesthesia for shoulder surgery with a low rate of side-effects. Thus, we performed a meta-analysis of randomised controlled trials (RCTs) to compare SCB with ISB for evaluating the efficacy and safety.
METHODS: The literature was searched from PubMed, Wiley Online Library, EMBASE, and the Cochrane Library
by two reviewers up to April 2017. All available RCTs written in English that met the criteria were included. Two authors pulled data from relevant articles and assessed the quality with the Cochrane Handbook. Review Manager 5.3 software was used to analyse the data.
RESULTS:Five RCTs and one prospective clinical study met the eligibility criteria and were included in the meta-analysis. We considered that there were no statistically significant differences between supraclavicular and interscalene groups in procedural time (P =0.81), rescue analgesia (P=0.53), and dyspnoea (P =0.6). The incidence of hoarseness and Horner syndrome was statistically lower in the SCB group than in the ISB group (P =0.0002 and P < 0.00001, respectively).
CONCLUSIONS: The meta-analysis showed that
ultrasound-guided SCB could become a feasible alternative technique to the ISB in shoulder surgery.
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