Comparative effectiveness of anterior and posterior approaches for interscalene brachial plexus block: A systematic review and meta-analysis
Eficácia comparativa das abordagens anterior e posterior para bloqueio do plexo braquial interescalênico: uma revisão sistemática e meta-análise
Luis Eduardo Ciconini; Theodoro Beck; Catreen Abouelsaad; Karandip Bains; Mauren F. Carbonar
Abstract
Introduction
Interscalene Brachial Plexus Blocks (ISBPB) are highly effective forms of anesthesia for surgeries involving the upper arm, shoulder, and neck. Recently, there has been a growing interest in comparing the advantages and limitations of the anterior and posterior approaches.
Methods
This systematic review and meta-analysis aimed to determine whether the anterior or posterior approach to ISBPB offers a clinical advantage regarding complete block rates and time to block completion. We included randomized controlled trials comparing the anterior and posterior techniques for ISBPB while excluding studies with overlapping populations, comparisons of blocks other than interscalene, and articles written in a non-English language
Results
The search strategy identified 2229 articles, of which six Randomized Controlled Trials (RCTs) met the inclusion criteria for the meta-analysis. A total of 414 patients were included, with 210 patients in the anterior group and 204 in the posterior group. The Odds Ratio (OR) for a complete sensory block between the two techniques did not reach statistical significance (OR = 0.56 [0.20, 1.58], 95% CI, p = 0.27). Similarly, the Standardized Mean Difference (SMD) for the time to complete the block also did not reach statistical significance (SMD: -0.77 [-2.12, 0.59], 95% CI, p = 0.27). Heterogeneity for complete block was not significant (I2 = 0%), while procedure time showed high heterogeneity (I2 = 97%).
Conclusions
Both techniques have shown effectiveness in providing surgical analgesia. The choice of technique should be determined by the provider’s comfort and proficiency, as well as ensuring the highest level of safety for the patient.
Keywords
Resumo
Introdução
Os bloqueios do plexo braquial interescalênico (ISBPB) são formas altamente eficazes de anestesia para cirurgias que envolvem a parte superior do braço, ombro e pescoço. Recentemente, tem havido um interesse crescente em comparar as vantagens e limitações das abordagens anterior e posterior.
Métodos
Esta revisão sistemática e meta-análise teve como objetivo determinar se a abordagem anterior ou posterior para ISBPB oferece uma vantagem clínica em relação às taxas de bloqueio completo e tempo para conclusão do bloqueio. Incluímos ensaios clínicos randomizados comparando as técnicas anterior e posterior para ISBPB, excluindo estudos com populações sobrepostas, comparações de bloqueios diferentes do interescalênico e artigos escritos em um idioma diferente do inglês.
Resultados
A estratégia de busca identificou 2229 artigos, dos quais seis Ensaios Clínicos Randomizados (RCTs) atenderam aos critérios de inclusão para a meta-análise. Um total de 414 pacientes foram incluídos, com 210 pacientes no grupo anterior e 204 no grupo posterior. A Odds Ratio (OR) para um bloqueio sensorial completo entre as duas técnicas não atingiu significância estatística (OR = 0,56 [0,20, 1,58], IC de 95%, p = 0,27). Da mesma forma, a Diferença Média Padronizada (SMD) para o tempo para completar o bloqueio também não atingiu significância estatística (SMD: -0,77 [-2,12, 0,59], IC de 95%, p = 0,27). A heterogeneidade para bloqueio completo não foi significativa (I2 = 0%), enquanto o tempo do procedimento mostrou alta heterogeneidade (I2 = 97%).
Conclusão
Ambas as técnicas demonstraram eficácia no fornecimento de analgesia cirúrgica. A escolha da técnica deve ser determinada pelo conforto e proficiência do provedor, bem como garantir o mais alto nível de segurança para o paciente.
Palavras-chave
References
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Submitted date:
02/20/2024
Accepted date:
10/22/2024
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