超声引导下胸腰筋膜平面阻滞对腰椎手术后镇痛效果影响的Meta分析

目的 评价超声引导下胸腰筋膜平面阻滞（TLIPB）对腰椎手术后镇痛效果的影响。
方法 计算机检索Pubmed、Embase、Cochrane Library、中国知网、万方、中国生物医学文献数据库，检索时间为建库至2020年12月。收集超声引导下TLIPB用于腰椎手术的随机对照文献，两位研究员参照纳入和排除标准独立筛选文献提取数据，参照Cochrane文件标准进行文献质量评价，采用RevMan 5.3软件进行数据分析处理。主要结局指标为术后VAS疼痛评分，次要结局指标为术后24 h补救镇痛率和术后不良反应（恶心呕吐、皮肤瘙痒、呼吸抑制）发生率。
结果 共纳入13篇随机对照研究，共计患者841例。与对照组比较，TLIPB组术后12 h静息时（SMD=-1.89，95%CI -3.27～-0.51，P<0.01）及运动时（SMD=-2.03，95%CI -3.32～-0.73，P<0.01）VAS疼痛评分明显降低；术后24 h静息时（SMD=-1.78，95%CI -2.74～-0.82，P<0.01）及运动时（SMD=-1.64，95%CI -2.18～-1.09，P<0.01）VAS疼痛评分明显降低；术后24 h补救镇痛率明显降低（OR=0.32，95%CI 0.19～0.55，P<0.05），术后恶心呕吐发生率明显降低（OR=0.32，95%CI 0.21～0.49，P<0.01）。两组皮肤瘙痒及呼吸抑制发生率差异无统计学意义。
结论 超声引导下胸腰筋膜平面阻滞可为腰椎手术患者提供较好的术后镇痛效果，且并发症更少。

Effect of ultrasound-guided thoracolumbar interfascial plane block on postoperative analgesia in lumbar surgery: a meta-analysis

Objective To systematically review and investigate the effect of ultrasound-guided thoracolumbar interfascial plane block (TLIPB) on postoperative analgesia in lumbar surgery.
Methods Pubmed, Embase, the Cochrane Library, CNKI, Wanfang and CBM databases were searched by computer from the date of database establishment up to December 2020. Randomized controlled trials involving the efficacy of ultrasound-guided TLIPB for analgesia after lumbar surgery were included. Two researchers screened the documents and extracted the data according to the inclusion and exclusion criteria independently, evaluated the literature quality according to the Cochrane document standards, and analyzed the data using Revman 5.3 software. The primary outcomes were VAS scores after operation, while secondary outcomes were the extra use of analgesics within 24 hours after surgery and the rate of postoperative adverse reactions (nausea and vomiting, pruritus, respiratory depression).
Results Thirteen randomized controlled trials involving 841 patients were finally included. Compared with the control group, TLIPB group had a lower VAS scores no matter at rest (SMD = -1.89, 95% CI -3.27 to -0.51, P < 0.01) or at movement (SMD = -2.03, 95% CI -3.32 to -0.73, P < 0.01) 12 hours after surgery; the TLIPB group had a lower VAS scores no matter at rest (SMD = -1.78, 95% CI -2.74 to -0.82, P < 0.01) or at movement (SMD = -1.64, 95% CI -2.18 to -1.09, P < 0.01) 24 hours after surgery. The incidence of extra use of analgesics within 24 hours after surgery (OR = 0.32, 95% CI 0.19 to 0.55, P < 0.05), and postoperative nausea and vomiting (OR = 0.32, 95% CI 0.21 to 0.49, P < 0.01) were significantly decreased in group TLIPB. There were no significant differences between the two groups for the incidence of skin itching and respiratory depression.
Conclusion TLIPB may have effective postoperative analgesia and few adverse effects for patients undergoing lumbar surgery.