【文献】腹腔镜胆囊切除术后腹横肌平面阻滞与伤口局部浸润麻醉用于最佳镇痛的比较:使用试验序贯分析进行的一项系统综述和Meta分析

2021

08/09

Luffy麻醉频道

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结论:有中高水平的证据表明，在腹腔镜胆囊切除术患者中，TAP阻滞的镇痛效果优于伤口局部浸润麻醉。

Abstract

Background

Background: Both transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. We undertook this systematic review and meta-analysis with trial sequential analysis to determine the best analgesic technique.

背景:腹腔镜胆囊切除术后，腹横肌平面(TAP)阻滞和伤口局部浸润麻醉均可缓解疼痛。我们使用试验序贯分析进行系统回顾和荟萃分析来确定最佳的镇痛技术。

Methods

Methods: We systematically searched the literature for trials comparing TAP block with wound infiltration after laparoscopic cholecystectomy. The primary outcome was pain score during rest (analogue scale, 0–10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, pain scores during movement and intravenous morphine consumption at 2, 12 and 24 h, and postoperative nausea and vomiting. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, hematoma, visceral injury and local anesthetic systemic toxicity.

方法:我们系统性地查阅了比较腹腔镜胆囊切除术后TAP阻滞与伤口局部浸润麻醉的文献。主要结局指标是术后2小时静息疼痛评分(模拟评分，0-10分)。次要疼痛相关结局指标包括术后12小时和24小时静息疼痛评分，术后2小时、12小时和24小时运动疼痛评分和静脉注射吗啡累计消耗量，以及术后恶心呕吐。其他次要结局指标包括阻滞相关并发症，如术后感染率、血肿、内脏损伤和局麻药全身毒性。

Results

Results: Ten trials including 668 patients were identified. There was a significant difference in pain score during rest at 2 postoperative hours in favour of TAP block when compared with wound infiltration (mean difference [95%CI]: −0.7 [−1.2, −0.2]; I2 = 71%; p = 0.008). Pain scores during rest at 12 and 24 h and pain scores during movement at 24 h were also significantly lower with TAP block than wound infiltration. Postoperative morphine consumption and the incidence of postoperative nausea and vomiting were significantly lower in patients who received a TAP block. Data were insufficient to compare block-related complications. The overall quality of evidence was moderate-to-high.

结果：10项试验，包括668例患者。与伤口局部浸润相比，TAP阻滞术后2小时静息疼痛评分有显著差异(平均值差值[95%置信区间]：−0.7[−1.2，−0.2];I2 = 71%;p = 0.008)。TAP阻滞组术后12小时和24 小时静息疼痛评分以及术后24 小时运动疼痛评分也明显低于伤口局部浸润组。接受TAP阻滞的患者术后吗啡消耗量和术后恶心和呕吐发生率显著降低。数据不足以比较阻滞相关并发症。证据的总体质量为中高。

Conclusions

Conclusions: There is moderate-to-high level evidence that the TAP block provides superior analgesia when compared with wound infiltration in patients undergoing laparoscopic cholecystectomy.

结论:有中高水平的证据表明，在腹腔镜胆囊切除术患者中，TAP阻滞的镇痛效果优于伤口局部浸润麻醉。

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