1 安徽医科大学第一附属医院麻醉科，合肥 230000
目的：系统评价前锯肌平面阻滞(serratus anterior plane block，SAPB)在乳腺癌改良根治术(modified radical mastectomy，MRM)患者中的镇痛效果。方法：检索PubMed、Embase、The Cochrane Library、万方、维普和CNKI数据库，采用RevMan5.4软件进行荟萃分析。结果：共纳入7项研究，荟萃分析结果显示SAPB组在术后静息时1、2、4、6、8、12、24 h，视觉模拟评分(visual analogue scale，VAS)较对照组低(P<0.05)。运动时SAPB组术后1、4、8、12和24 h的VAS评分显著低于对照组(P<0.05)。SAPB组术后24 h内按压患者自控镇痛泵(patient-controlled analgesia，PCA)次数及阿片类药物用量均显著低于对照组(P<0.05)。SAPB组在减少阿片类药物相关不良反应方面也具有优势(P<0.05)，但在缩短手术时间方面2组差异无统计学意义(P>0.05)。结论：SAPB可以提供较好的MRM术后镇痛效果，并且在减少阿片类药物不良反应方面具有显著优势。然而，对手术时间没有明显的影响。
A meta-analysis of serratus anterior plane block for analgesia after modified radical mastectomy
CorrespondingAuthor: LIU Xuesheng
This work was supported by the National Natural Sciences Foundation of China (81870841).
Objective: To systematically review the analgesic effect of serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM). Methods: PubMed, Embase, The Cochrane Library, Wanfang Data, VIP and CNKI were searched and this meta-analysis was performed by RevMan5.4 software. Results: A total of 7 RCTs were included in meta-analysis. The results showed that the visual analoguescale (VAS) score in the SAPB group was lower than that in the control group at 1, 2, 4, 6, 8, 12, 24 h after resting (P<0.05). During exercise, the VAS scores of SAPB group at 1, 4, 8, 12 and 24 h after operation were significantly lower than those of control group (P<0.05). Additionally, the number of pressing patient-controlled analgesia (PCA) and postoperative opioid consumption within 24 hours after operation were signiﬁcantly lower than those in the SAPB groups (P<0.05). There was also an advantage in reducing opioid-related adverse reactions (P<0.05), but there was no statistically significant difference in shortening operative time (P>0.05). Conclusion: SAPB could provide better postoperative analgesia and had more effective advantages in adverse effects after MRM. However, there was no significant advantage in shortening operative time.
serratus anterior plane block; modified radical mastectomy; analgesia; Meta-analysis