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首页> 外文期刊>Anesthesia and Analgesia: Journal of the International Anesthesia Research Society >Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
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Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

机译：区域镇痛加入全身麻醉与全身麻醉加上儿童心脏手术的全身镇痛：随机临床试验的系统评价和荟萃分析。

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The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia. Risks of bias of included trials were judged with the Cochrane tool. Data were analyzed with fixed- (I < 25%) or random-effects models (I ≥ 25%). The quality of evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation working group scale. We included 14 randomized controlled trials with 605 participants (312 to RA and 293 to the comparator). RA reduces pain up to 24 hours after surgery. At 6-8 hours after surgery, the standardized mean difference was -0.81 (95% confidence interval [CI], -1.22 to -0.40; low-quality evidence). We did not find a difference for nausea and vomiting (risk ratio [RR], 0.89; 95% CI, 0.61-1.31; very low-quality evidence), duration of tracheal intubation (standardized mean difference, -0.18; 95% CI, -0.40 to 0.05; low-quality evidence), intensive care unit length of stay (mean difference, -0.10 hours; 95% CI, -1.31 to 1.12 hours; low-quality evidence), hospital length of stay (mean difference, -0.02 days; 95% CI, -1.16 to 1.12 days; low-quality evidence), reoperation (RR, 0.76; 95% CI, 0.17-3.28; low-quality evidence), death (RR, 0.50; 95% CI, 0.05-4.94; low-quality evidence), and respiratory depression (RR, 2.06; 95% CI, 0.20-21.68; very low-quality evidence). No trial reported signs of local anesthetic toxicity or lasting neurological or infectious complications related to the RA techniques. One trial reported 1 transient ipsilateral episode of diaphragmatic paralysis with intrapleural analgesia that resolved with cessation of local anesthetic administration. Compared to systemic analgesia, RA techniques reduce postoperative pain up to 24 hours in children undergoing cardiac surgery. Currently, there is no evidence that RA for pediatric cardiac surgery has any impact on major morbidity and mortality. These results should be interpreted cautiously because they represent a meta-analysis of small and heterogeneous studies. Further studies are needed.
机译：该系统审查的目的是比较区域镇痛（RA）技术对术后疼痛，恶心和呕吐，资源利用，重新组合，死亡和经历心脏手术的镇痛技术的并发症的影响。搜索在2018年5月在PubMed，Embase和Cochrane中央登记术中完成了可随机对照试验的受控试验，比较了具有全身镇痛的RA技术。用Cochrane工具判断包括试验的偏差风险。用固定的（I <25％）或随机效果模型（I≥25％）分析数据。根据建议评估，发展和评估工作组规模的评分进行评分证据质量。我们包括14项随机对照试验，605名参与者（312至RA和293到比较者）。 Ra在手术后减少24小时的疼痛。手术后6-8小时，标准化平均差异为-0.81（95％置信区间[CI]，-1.22至-0.40;低质量证据）。我们没有发现恶心和呕吐的差异（风险比[RR]，0.89; 95％CI，0.61-1.31;非常低质量的证据），气管插管持续时间（标准化平均差异，-0.18; 95％CI， -0.40至0.05;低质量的证据），重症监护单位住宿时间（平均差异， - 0.10小时; 95％CI，-1.31至1.12小时;低质量证据），住院时间（平均差异）（平均差异， - 0.02天; 95％CI，-1.16至1.12天;低质量的证据），重新组合（RR，0.76; 95％CI，0.17-3.28;低质量证据），死亡（RR，0.50; 95％CI，0.05 -4.94;低质量证据）和呼吸抑制（RR，2.06; 95％CI，0.20-21.68;非常低质量的证据）。没有试验报道局部麻醉毒性或持久的神经系统或传染性与RA技术相关的迹象。一项试验报告了膈肌瘫痪的1次瞬态同侧，胸腔内镇痛，随着局部麻醉给药的停止解决。与系统性镇痛相比，RA技术减少了心脏手术的儿童术后24小时的术后疼痛。目前，没有证据表明RA用于儿科心脏手术对主要发病率和死亡率产生任何影响。这些结果应谨慎地解释，因为它们代表了对小型和异质研究的荟萃分析。需要进一步研究。

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