【罂粟摘要】腰方肌阻滞与腹横肌平面阻滞用于剖宫产的系统评价和网络Meta分析

腰方肌阻滞与腹横肌平面阻滞用于剖宫产的系统评价和网络Meta分析

贵州医科大学 高鸿教授课题组

翻译：佟睿 编辑：佟睿 审校：曹莹

 总结

剖宫产是全球最常见的住院手术。如果没有妥善治疗，剖宫产的术后疼痛可达中重度，并且是病人主要关注的麻醉问题。横腹肌平面阻滞和腰方肌阻滞是可能改善剖宫产术后镇痛的筋膜平面阻滞。尽管腰方肌阻滞术的支持者认为，与腹横肌平面阻滞相比，这种技术可能提供更好的镇痛效果，但目前直接比较这两种技术的数据有限。因此，我们进行了一项系统回顾和网络Meta分析，以比较腹横肌平面和腰方肌阻滞入路，寻找随机对照试验，比较两种技术在鞘内注射吗啡或不使用吗啡的效果。我们搜索到共31个试验，包含2188名患者，其中12个试验报告了我们的主要观察指标，即24小时内静脉注射吗啡当量的累积消耗量。在鞘内不注射吗啡的情况下，腹横肌平面阻滞和腰方肌阻滞效果相当，且均优于对照组(中等质量证据)。在鞘内注射吗啡的情况下，对照组、横腹肌平面阻滞和腰方肌阻滞之间也不存在差异(中等质量的证据)。尽管腰方肌阻滞组在36h的疼痛评分低于腹横肌平面阻滞(证据质量很低)，但这两种技术在4~6h、8~12h、24h和36h的静息和活动疼痛评分上均有相似的结果。然而，与鞘内注射吗啡的无效对照相比，腹横肌平面阻滞与术后恶心呕吐(中等质量证据)和镇静的发生率降低相关(低质量证据)。所以目前没有足够的数据来得出明确的结论，在没有鞘内吗啡注射的情况下，腹横肌平面阻滞和腰方肌阻滞似乎优于对照，但当鞘内注射吗啡时，产生的额外优势与非主动控制相比效果有限。

Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis

      Summary    

Caesarean delivery is the most commonly performed inpatient surgical procedure globally. Pain after caesarean delivery is moderate to severe if not adequately treated, and is a primary anaesthetic concern for patients. Transversus abdominis plane and quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following caesarean delivery. Although proponents of the quadratus lumborum block suggest that this technique may provide better analgesia compared with transversus abdominis plane block, there are limited data directly comparing these two techniques. We, therefore, performed a systematic review and network meta-analysis to compare transversus abdominis plane and quadratus lumborum block approaches, seeking randomised controlled trials comparing both techniques to each other, or to control, with or without intrathecal morphine. In all, 31 trials with 2188 patients were included and our primary outcome, the cumulative intravenous morphine equivalent consumption at 24 h, was reported in 12 trials. In the absence of intrathecal morphine, transversus abdominis plane and quadratus lumborum blocks were equivalent, and both were superior to control (moderate-quality evidence). In the presence of intrathecal morphine, no differences were found between control, transversus abdominis plane and quadratus lumborum blocks (moderate-quality evidence). Similar results were found for resting and active pain scores at 4–6 h , 8–12 h, 24 h and 36 h, although quadratus lumborum block was associated with lower pain scores at 36 h when compared with transversus abdominis plane block (very low-quality evidence). However, transversus abdominis plane block was associated with a reduced incidence of postoperative nausea and vomiting (moderate-quality evidence) and sedation when compared with inactive control following intrathecal morphine administration (low-quality evidence). There are insufficient data to draw definitive conclusions, but transversus abdominis plane and quadratus lumborum block appear to be superior to control in the absence of intrathecal morphine, but provide limited additional benefit over inactive control when intrathecal morphine is also used.

翻译：佟睿    编辑：佟睿    审校：曹莹

贵州医科大学 高鸿教授课题组

来源：罂粟花

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