腰方肌阻滞与腹横肌平面阻滞用于成人腹部手术术后镇痛效果的Meta分析

目的评价超声引导下腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)在成人腹部手术术后镇痛的效果。方法检索Cochrane、Pubmed、Embase、中国知网、万方和维普数据库,纳入腰方肌阻滞(QLB组)与腹横肌平面阻滞(TAP组)在成人腹部手术后镇痛比较的随机对照试验(RCT)。主要结局指标为术后VAS疼痛评分,次要结局指标包括术后24 h内补救性镇痛率及术后不良反应发生率。采用RevMan 5.3进行Meta分析。结果最终纳入19项RCTs,共1412例患者。与TAP组比较,QLB组术后8 h静息(MD=-0.29, 95%CI-0.52～-0.06,P0.05)及运动状态(MD=-0.47, 95%CI-0.80～-0.14,P0.05)和12h静息(MD=-0.30,95%CI-0.48～-0.13,P0.05)及运动状态(MD=-0.68, 95%CI-1.03～-0.33,P0.05)时VAS评分均明显降低。QLB组术后24 h内补救性镇痛率明显低于TAP组(RR=0.27, 95%CI 0.17～0.42,P0.05),同时恶心呕吐、眩晕的发生率明显低于TAP组(RR=0.37, 95%CI 0.24～0.56,P0.05; RR=0.29, 95%CI 0.14～0.57,P0.05)。结论腰方肌阻滞用于成人腹部手术术后镇痛效果优于腹横肌平面阻滞,且不良反应更少。

Quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after adult abdominal surgery: a meta-analysis

Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block (QLB) and transversus abdominis plane (TAP) block for postoperative analgesia among adult patients after abdominal surgery.
Methods Literatures were retrieved from databases including Cochrane Library, Pubmed, Embase, CNKI, WanFang and VIP. We used RevMan5.3 software to synthesis data according to the rule of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our primary outcomes were the visual analogue scale (VAS) scores at 8 h,12 h, 24 h and 48 h after surgery, while secondary outcomes were the extra use of analgesics 24 h after surgery, the rate of postoperative adverse events.
Results Nineteen RCTs involving 1412 patients were included. Meta-analysis of these studies showed that compared with group TAP, group QLB had a lower VAS scores no matter at rest or at movement 8 h after surgery (MD = -0.29, 95% CI -0.52 to -0.06, P < 0.05; MD = -0.47, 95% CI -0.80 to - 0.14, P < 0.05) and 12 h after surgery (MD = -0.30, 95% CI -0.48 to -0.13, P < 0.05; MD = -0.68, 95% CI -1.03 to -0.33, P < 0.05). There was no significant difference between these two group for the VAS scores at postoperative 24 h and 48 h. The extra use of analgesics at postoperative 24 h (RR = 0.27, 95% CI 0.17 to 0.42, P < 0.05) were higher in the group TAP after surgery. The incidence of nausea, vomiting (RR = 0.37, 95% CI 0.24 to 0.56, P < 0.05) and dizziness (RR = 0.29, 95% CI 0.14 to 0.57, P < 0.05) after surgery were less in the group QLB.
Conclusion Compared with TAP block, the use of quadratus lumborum block has better analgesia effect and fewer adverse effects after abdominal surgery among adults.