【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

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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,腹横平面(TAP)阻滞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。主要结局指标术后2小时静息疼痛评分(模拟评分,0-10)次要疼痛相关结局指标包括术后12小时24小时静息疼痛评分,术后2小时12小时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、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24 小时静息疼痛评分以及术后24 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: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

Figures&Tables



1 Cochrane协作偏倚风险总结:对所有纳入研究的偏倚风险进行评估。绿圈,低偏倚风险;红圈,高偏倚风险;黄圈,不清楚偏差风险(有关此图例中相关颜色的解释,请读者参考本文的web版本)




1 试验特点。iv 静脉注射;PCA 患者自控镇痛



2 TAP阻滞VS伤口局部浸润麻醉腹腔镜胆囊切除术患者术后2小时静息疼痛评分



3 试验序贯分析术后2小时静息疼痛评分。蓝色曲线越过红色曲线,这有力地证明了TAP阻滞优于无TAP阻滞(有关此图例中相关颜色的解释,请读者参考本文的web版本)



2 次要疼痛相关结局指标CI 置信区间NA 不适用  



3 每一个结局指标的证据质量评估 PONV 术后恶心呕吐;LAST 局部麻醉药全身毒性


文献笔记


文献笔记





统计学小知识


统计学小知识


 

1.TSA(trial sequential analysis):试验序贯分析,用于系统综述或Meta分析样本量估算


2.偏倚

翻译:苗 猫 丹妮



本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
腹横肌,局部,镇痛,浸润,阻滞,静息

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