腰方肌阻滞应用于腹部手术术后镇痛效果的系统评价

Effect of quadratus lumborum block on the postoperative analgesia in patients undergoing abdominal surgery:A systematic evaluation

目的:系统评价腰方肌阻滞应用于腹部手术术后镇痛的有效性。方法:计算机检索维普、万方、CNKI、EBSCO、PubMed、Web of Science、Embase、Cochrane Library等数据库,收集从建库到2018年8月所有关于腰方肌阻滞用于成人腹部手术术后镇痛效果的随机对照试验。采用ReMan 5.0进行Meta分析。结果:共纳入8篇RCTs,533例患者,Meta分析结果示:与对照组相比,腰方肌组术后24 h阿片类镇痛药使用量显著减少[MD =-5.05,95%CI(-6.52,-3.58),P < 0.05];术后24 h静息时[MD =-1.13,95%CI(-1.80,-0.46);P < 0.05]和运动时[MD =-1.65,95%CI(2.48,-0.81);P < 0.05]的VAS评分降低;术后镇痛满意度提高[MD = 2.51,95%CI(2.25, 2.78),P < 0.05]。结论:腰方肌阻滞用于腹部手术术后镇痛,能减少术后阿片类药物使用量,降低术后疼痛,提高术后镇痛满意度,是腹部手术多模式镇痛的一种可供选择的方式。

Objective: To systematically evaluate the effect of quadratus lumborum block (QLB) on the postoperative analgesia in patients undergoing abdominal surgery. Methods: Randomized controlled trials (RCTs) of the effect of quadratus lumborum block for postoperative analgesia in adult patients undergoing abdominal surgery published up to August 2018 were collected by searching databases including VIP, WanFang Data, CNKI, EBSCO, PubMed, Web of Science, Embase, and the Cochrane Library. A meta-analysis was performed by ReMan 5.0. Results: Eight RCTs involving 533 patients were identified. Meta-analysis of these studies showed that compared with the control group, the QLB group had significantly lower amount of opioid analgesics (mean deviation [MD]=-5.05, 95% confidence interval [CI]=-6.52 to -3.58, P < 0.05) at 24 hours post-surgery, lower Visual Analogue Scale scores at rest (MD =-1.13, 95% CI =-1.80 to -0.46, P < 0.05) and during exercise (MD =-1.65, 95% CI =-2.48 to -0.81, P <0.05) at 24 hours post-surgery, and higher postoperative analgesia satisfaction (MD = 2.51, 95% CI = 2.25 to 2.78, P < 0.05). Conclusion: The use of QLB for postoperative analgesia in patients undergoing abdominal surgery decreases the amount of opioid analgesics, reduces the intensity of postoperative pain, and increases the satisfaction with postoperative analgesia. It is an alternative method for multimode analgesia following abdominal surgery.