腹横肌平面阻滞与切口局部浸润镇痛效果比较的Meta分析

Transversus abdominis plane block versus local anaesthetic wound infiltration for analgesia: a meta-analysis

目的比较成人腹横肌平面阻滞和切口局部浸润在全麻下腹部手术后的镇痛效果。方法计算机检索中英文数据库,纳入比较腹横肌平面阻滞和切口局部浸润的随机对照试验,用Rev Man5.3软件分析评价这两种技术对术后镇痛效果的差异。结果共纳入8个随机对照试验,共计447例患者。(1)腹横肌平面阻滞与切口局部浸润的术后1 h静息疼痛评分无明显差异[WMD=-0.33,95%CI=(-0.78,0.12),P=0.15],但术后1 h腹横肌平面阻滞比切口局部浸润的咳嗽或运动疼痛评分低[WMD=-1.09,95%CI=(-1.85,-0.32),P=0.006];(2)术后6 h腹横肌平面阻滞比切口局部浸润的静息及咳嗽或运动评分均低[WMD=-0.69,95%CI=(-1.04,-0.35),P<0.0001)],[WMD=-0.71,95%CI=(-1.32,-0.10),P=0.02];(3)术后12 h腹横肌平面阻滞比切口局部浸润的静息疼痛评分低[WMD=-0.56,95%CI=(-1.02,-0.09),P=0.02];(4)术后24 h腹横肌平面阻滞比切口局部浸润的静息疼痛评分低[WMD=-0.35,95%CI=(-0.65,-0.05),P=0.02],但咳嗽或运动时疼痛评分无显著差异[WMD=-0.47,95%CI=(-1.17,0.24),P=0.19]。结论腹横肌平面阻滞较切口局部浸润在全麻下成人腹部手术后镇痛方面于术后中期在统计学意义上略有优势,但在临床意义上两种方式的镇痛效果差别不大。

Objective To compare the analgesic effects of transversus abdominis plane（ TAP） block and local anaesthetic wound infiltration on general anesthesia in adult abdominal surgery. Methods We searched Chinese and English databases for randomized controlled trials（ RCTs） comparing TAP block with wound infiltration for pain relief after abdominal surgery by computer. Rev Man 5. 3 software was used for data analysis. Results 8 RCTs with a total of 447 participants were included.（ 1） There was no significant difference between TAP block and local anaesthetic wound infiltration for postoperative rest pain scores 1 hour after operation[WMD =-0. 33,95% CI =（-0. 78,0. 12）,P = 0. 15],but TAP block was associated with apparent lower movement pain scores 1 hour after operation than wound infiltration[WMD =-1. 09,95% CI =（-1. 85,-0. 32）,P = 0. 006].（ 2） TAP block was associated with lower rest pain scores and movement pain scores 6 hours after operation than wound infiltration[WMD =-0. 69,95% CI =（-1. 04,-0. 35）,P〈0. 0001],[WMD =-0. 71,95% CI =（-1. 32,-0. 10）,P = 0. 02].（ 3）TAP block was associated with significant lower rest pain scores 12 hours after operation than wound infiltration[WMD =-0. 56,95% CI =（-1. 02,-0. 09）,P = 0. 02].（ 4） TAP block was associated with significant lower rest pain scores 24 hours after operation than wound infiltration[WMD =-0. 35,95% CI =（-0. 65,-0. 05）,P = 0. 02],however,there was no significant difference between TAP block and local anaesthetic wound infiltration for postoperative movement pain scores 24 hours after operation[WMD =-0. 47,95% CI =（-1. 17,0. 24）,P = 0. 19]. Conclusion TAP block has a better anaesthetic effect than wound infiltration in the intermediate-term of postoperation statistically,but there is no significant difference in the anaesthetic effect between the two anesthetic methods clinically.