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首页> 外文期刊>Canadian journal of anesthesia: Journal canadien d'anesthesie >Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: Multiple treatment comparison
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Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: Multiple treatment comparison

机译：补充性周围神经阻滞在髋部骨折手术中的疗效：多种治疗方法的比较

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Purpose: This study was designed to determine the most effective peripheral nerve block supplement to standard anesthesia management for hip fracture patients. Methods: We systematically reviewed randomized controlled trials (RCTs) published from 1990 to 2010 and conducted multiple treatment comparisons using direct and indirect evidence for two outcomes, i.e., acute pain intensity and delirium. We combined trials by type of injection (regardless of time of insertion during the perioperative phase, use of nerve block catheter, local anesthetic type, additives, or duration of treatment). Results: Twenty-one RCTs comprising 1,422 participants were included. In most cases, the trials were conducted in Europe; they excluded patients with cognitive impairment, and they were unclear or at high risk of bias. The combination of obturator and lateral femoral cutaneous nerve blockade had the highest probability of being the most effective against acute postoperative pain. Fascia iliaca blockade had the highest probability of being the most effective against delirium. There was no difference in outcomes among other nerve blocks. Conclusion: Not all nerve blocks are equally effective in improving outcomes after hip fracture. Multiple treatment comparison, a tool to compare the effectiveness of multiple treatments simultaneously, provides useful guidance to anesthesia providers seeking effective treatment when faced with a body of RCTs wherein each investigates one treatment. More RCTs comparing multiple nerve blocks in hip fracture are needed.
机译：目的：本研究旨在确定髋部骨折患者在标准麻醉管理中最有效的周围神经阻滞补充剂。方法：我们系统回顾了1990年至2010年发布的随机对照试验（RCT），并使用直接和间接证据对急性疼痛强度和del妄这两个结果进行了多次治疗比较。我们根据注射类型（无论围手术期插入时间，使用神经阻滞导管的使用，局部麻醉类型，添加剂或治疗时间长短）进行合并试验。结果：包括21个RCT，包括1,422名参与者。在大多数情况下，试验是在欧洲进行的。他们排除了认知障碍患者，他们不清楚或有偏见的高风险。闭孔和股外侧皮神经阻滞的联合使用对急性术后疼痛最有效。 ilia筋膜封堵术对against妄最有效的可能性最高。其他神经阻滞的预后没有差异。结论：并非所有神经阻滞在改善髋部骨折后的疗效方面均具有同等效力。多重治疗比较是一种同时比较多种治疗效果的工具，它为麻醉提供者面对大量RCT时寻求有效治疗的麻醉提供者提供了有用的指导，而每个患者都在研究一种治疗。需要更多的RCT来比较髋部骨折中的多个神经阻滞。

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