PURPOSE To investigate postoperative pain variations in vitreoretinal surgeries conducted with combined regional-general anesthesia or general anesthesia. DESIGN Systematic review and meta-analysis. METHODS A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted to identify relevant randomised controlled trials (RCTs) published before December 26, 2023. Studies comparing vitreoretinal surgeries conducted under combined anesthesia to general anesthesia were included, while studies using only regional anesthesia were excluded. The quality of the studies was assessed using the Cochrane Collaboration risk of bias tool, and the results are presented as odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). I2 statistic was calculated to assess heterogeneity. The primary outcomes in our study included the proportions of patients needing as-needed postoperative analgesics, dosage of as-needed postoperative analgesia medications, and time to the first demand for as-needed postoperative analgesia. The secondary outcomes included postoperative pain scores at 0.5, 1, 2, 4, 6, 12, 24 hours (h), duration of surgery and anesthesia, and percentage of patients experiencing postoperative nausea and vomiting (PONV). RESULTS A total of 19 RCTs involving 1314 patients were analysed. Combined anesthesia was associated with lower proportions of patients needing as-needed postoperative analgesics (OR, 0.218 95% CI, 0.114 to 0.418, I2 = 55.2%), reduced dosage of as-needed postoperative analgesia medications (SMD, -1.429, 95% CI, -2.395 to -0.462, I2 = 90.4%), and longer time to the first demand for as-needed postoperative analgesia compared with general anesthesia alone (SMD, 2.650, 95% CI, 1.169 to 4.132, I2 = 96.5%). The effect of additional regional anesthesia lasted for 6 hours (0.5h SMD, -1.471, 95% CI, -2.498 to -0.444, I2 = 90.5%; 1h, -1.507, -2.309 to -0.705, 92.7%; 2h -1.487, -2.300 to -0.674, 93.2%; 4h -1.052, -1.708 to -0.396, 89.5%; 6h -1.053, -1.932 to -0.174, 93.4%; 12h -0.286, -0.648 to 0.076, 57.1%; 24h -0.297, -0.624 to 0.029, 64.0%). Combined anesthesia decreased PONV risk without affecting the surgical or anesthesia duration. CONCLUSIONS Combined anesthesia demonstrated additional postoperative analgesic effects versus general anesthesia only. Further research is needed to validate the results of our study and to identify vision-threatening complications.

中文翻译：

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区域全身麻醉联合与全身麻醉玻璃体视网膜手术的术后疼痛：系统评价和荟萃分析。


目的 探讨区域全身麻醉或全身麻醉联合进行的玻璃体视网膜手术的术后疼痛变化。设计 系统评价和荟萃分析。方法 对 PubMed、Embase 和 Cochrane Library 数据库进行系统检索，以确定 2023 年 12 月 26 日之前发表的相关随机对照试验 （RCT）。纳入了比较联合麻醉下进行的玻璃体视网膜手术与全身麻醉的研究，而仅使用区域麻醉的研究被排除在外。使用 Cochrane 协作偏倚风险工具评估研究质量，结果以比值比 （ORs） 或标准化均数差 （SMD） 和 95% 置信区间 （CIs） 表示。计算 I2 统计量以评估异质性。我们研究的主要结局包括需要按需术后镇痛药的患者比例、按需术后镇痛药物的剂量以及首次需要术后镇痛的时间。次要结局包括 0.5 、 1 、 2 、 4 、 6 、 12 、 24 小时 （h） 的术后疼痛评分、手术和麻醉持续时间以及术后恶心和呕吐 （PONV） 患者的百分比。结果 共分析了 19 篇 RCT，涉及 1314 例患者。与单独全身麻醉相比，联合麻醉与需要按需镇痛药的患者比例较低 （OR， 0.218 95% CI， 0.114 至 0.418， I2 = 55.2%）、术后按需镇痛药物剂量减少 （SMD， -1.429， 95% CI， -2.395 至 -0.462， I2 = 90.4%） 相关，并且与单独全身麻醉相比，首次需要按需术后镇痛的时间更长 （SMD， 2.650， 95% CI，1.169 至 4.132，I2 = 96.5%）。 额外区域麻醉的效果持续 6 小时（0.5 小时 SMD，-1.471,95% CI，-2.498 至 -0.444，I2 = 90.5%;1 小时，-1.507，-2.309 至 -0.705,92.7%;2 小时 -1.487，-2.300 至 -0.674,93.2%;4 小时 -1.052，-1.708 至 -0.396,89.5%;6 小时 -1.053，-1.932 至 -0.174,93.4%;12 小时 -0.286，-0.648 至 0.076,57.1%;24 小时 -0.297，-0.624 至 0.029,64.0%）。联合麻醉降低了 PONV 风险，而不影响手术或麻醉持续时间。结论 与仅全身麻醉相比，联合麻醉显示出额外的术后镇痛作用。需要进一步的研究来验证我们的研究结果并确定威胁视力的并发症。