腰方肌阻滞与腹横肌平面阻滞用于腹部手术后镇痛效果的比较:meta分析

Comparison of Quadrat Lumborum Block and Transversus Abdominis Plane Block inAnalgesia After Abdominal Surgery:Meta-Analysis

目的通过meta分析比较腰方肌阻滞(QLB)与腹横肌平面阻滞(TAP)在腹部手术后的镇痛效果。方法通过计算机检索Cochrane Library、PubMed、Web of Science、EMBASE、中国知网、万方和中国生物医学数据库等,搜索QLB与TAP用于腹部手术后镇痛的随机对照试验,检索时限从建库至2022年10月。文献的筛选、资料的提取及对纳入文献偏倚风险的评估由2位研究者独立进行,之后采用RevMan 5.4进行meta分析。结果共纳入11篇文献,共825例患者,其中QLB组405例,TAP组420例。meta分析结果显示:与TAP组相比,QLB组术后24 h静态疼痛评分低(P=0.010),术后48 h静态和动态疼痛评分低(P=0.006);术后24 h内阿片类药物消耗量减少(P=0.003),恶心呕吐发生率低(P=0.020);术后下床活动时间、首次排气时间及住院时间缩短(P<0.05)。结论腹部手术后QLB镇痛效果优于TAP,且不良反应少,术后恢复快,住院时间短。

Objective A meta-analysis was performed to compare the efficacy of quadrat lumborum block(QLB)and transversus abdominis plane block(TAP)in postoperative abdominal analgesia.Methods Databases such as Cochrane Library,PubMed,Web of Science,EMBASE,CNKI,Wanfang Data and CBM were searched using computers from inception to October 2022.Randomized controlled trials of QLB and TAP for postoperative analgesia after abdominal surgery were searched.Literature screening,data extraction and risk assessment of the included literature were all conducted independently by two authors,and then meta-analysis was performed using RevMan 5.4.Results A total of 11 articles were included,involving a total of 825 patients,including 405 in the QLB group and 420 in the TAP group.Meta analysis results showed that compared with the TAP group,the static pain score of the QLB group was lower at 24 hours after surgery(P=0.010),and the static and dynamic pain scores were lower at 48 hours after surgery(P=0.006).Opioid consumption decreased(P=0.003)and incidence of nausea and vomiting decreased(P=0.020)within 24 hours after surgery.The time of getting out of bed,the time of first exhaust and the length of hospital stay were shortened(P<0.05).Conclusion The analgesic effect of QLB for abdominal surgery is better than TAP,and the adverse reactions are less,the postoperative recovery is faster,and the hospital stay is shorter.