Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis
Bloqueio do plano eretor da espinha para analgesia após cesariana: uma revisão sistemática com metanálise
Idelberto do Val Ribeiro Junior, Vanessa Henriques Carvalho, Luiz Gustavo Oliveira Brito
Abstract
Background
Erector spinae plane block (ESPB) is a regional block that may be used for several surgeries. However, the evidence regarding obstetrical procedures is not pooled in the literature.
Objectives
to assess whether ESPB improves the postoperative pain after cesarean section by a systematic review and meta-analysis.
Methods
The protocol of this review was registered on PROSPERO (CRD42020192760). We included randomized controlled trials from databases until August 2020. The primary outcome was pain measured on a visual analogic scale; secondary outcomes were analgesic duration, postoperative opioid dose within the 24 hours, nausea/vomiting. The risk of bias and the GRADE criteria to assess quality of evidence were analyzed.
Results
From 436 retrieved studies, three were selected. There was no difference in the pain scores between ESPB and controls at rest after surgery at 4 h (mean difference [MD] = 0.00; 95% CI: -0.72 to 0.72; I² = 0%; very low certainty), 12 h (MD = -1.00; 95% CI: -2.00 to -0.00; I² = 0%, low certainty) and 24 h (MD = -0.68; 95% CI: -1.56 to 0.20; I² = 50%; very low certainty). There was a smaller consumption of tramadol with ESPB compared with controls (MD = -47.66; 95% CI: -77.24 to -18.08; I² = 59%; very low certainty). The analgesic duration of ESPB was longer than the controls (MD = 6.97; 95% CI: 6.30 to 7.65; I² = 58%; very low certainty).
Conclusion
ESPB did not decrease the postoperative pain scores when compared to other comparators. However, ESPB showed a lower consumption of tramadol and a longer blockade duration, although the quality of evidence of these outcomes were very low.
Keywords
Resumo
Justificativa: O bloqueio do plano eretor da espinha (BPEE) é um bloqueio regional que pode ser utilizado em diversas cirurgias. No entanto, as evidências sobre procedimentos obstétricos não estão reunidas na literatura. Objetivos: Avaliar se a BPEE melhora a dor pós-operatória após cesariana por meio de revisão sistemática e metanálise. Métodos: O protocolo desta revisão foi registrado no PROSPERO (CRD42020192760). Incluímos ensaios clínicos randomizados de bancos de dados até agosto de 2020. O desfecho primário foi dor medida em uma escala analógica visual; desfechos secundários foram duração analgésica, dose de opióide pós-operatória dentro de 24 horas, náusea/vômito. O risco de viés e os critérios GRADE para avaliar a qualidade da evidência foram analisados. Resultados: Dos 436 estudos recuperados, três foram selecionados. Não houve diferença nos escores de dor entre BPEE e controles em repouso após a cirurgia em 4 h (diferença média [DM] = 0,00; IC 95%: -0,72 a 0,72; I² = 0%; certeza muito baixa), 12 h ( DM = -1,00; IC 95%: -2,00 a -0,00; I² = 0%, certeza baixa) e 24 h (DM = -0,68; IC 95%: -1,56 a 0,20; I² = 50%; certeza muito baixa) . Houve menor consumo de tramadol com BPEE em relação aos controles (DM = -47,66; IC 95%: -77,24 a -18,08; I² = 59%; certeza muito baixa). A duração analgésica do BPEE foi maior que os controles (DM = 6,97; IC 95%: 6,30 a 7,65; I² = 58%; certeza muito baixa). Conclusão: O BPEE não diminuiu os escores de dor pós-operatória quando comparado a outros comparadores. No entanto, o BPEE apresentou menor consumo de tramadol e maior duração do bloqueio, embora a qualidade da evidência desses desfechos tenha sido muito baixa.
Palavras-chave
References
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