腹横肌平面阻滞对结直肠手术后疼痛的影响:一项随机对照试验的荟萃分析。
Effect of Transversus Abdominis Plane Block on Postoperative Pain after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials.
出版信息
Med Princ Pract. 2018;27(2):158-165. doi: 10.1159/000487323. Epub 2018 Feb 1.
OBJECTIVES
To assess the analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colorectal surgery (CRS).
MATERIALS AND METHODS
The databases of PubMed, ISI Web of Science, and Embase were searched, and randomized controlled studies (RCTs) that compared TAP block to control for relief of postoperative pain in patients who underwent CRS were included. Outcomes, including postoperative pain at rest and with movement, morphine use, postoperative nausea and vomiting, and the length of hospital stay, were analyzed using STATA software. The weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) or relative risk with 95% CI were used to present the strength of associations.
RESULTS
A total of 7 RCTs with 511 patients were included. The results of this study suggested that TAP block significantly relieved postoperative pain during postanesthetic recovery after CRS at rest and during movement (WMDs were -0.98 [95% CI -1.57 to -0.38] and -0.68 [-1.07 to -0.30], respectively), and also decreased pain intensity during movement 24 h after CRS (WMD: -0.57 [95% CI -1.06 to -0.08]). TAP block significantly reduced opioid consumption within 24 h when compared to controls, with a WMD of 15.66 (95% CI -23.93 to -7.39). However, TAP block did not shorten the length of hospital stay.
CONCLUSIONS
TAP block was an effective approach for relief of postoperative pain and reduced postoperative consumption of morphine. More RCTs with large sample sizes are required to confirm these findings.
目的
评估腹横肌平面(TAP)阻滞在结直肠手术(CRS)患者中的镇痛效果。
材料和方法
检索 PubMed、ISI Web of Science 和 Embase 数据库,纳入比较 TAP 阻滞与对照组缓解 CRS 术后疼痛的随机对照研究(RCT)。使用 STATA 软件分析术后静息和运动时疼痛、吗啡用量、术后恶心呕吐和住院时间等结局。使用加权均数差值(WMD)及其 95%置信区间(95%CI)或相对风险及其 95%CI 表示关联强度。
结果
共纳入 7 项 RCT 共 511 例患者。结果表明,TAP 阻滞可显著缓解 CRS 术后麻醉恢复期静息和运动时的术后疼痛(WMD 分别为-0.98[95%CI-1.57 至-0.38]和-0.68[-1.07 至-0.30]),还可降低 CRS 后 24 小时运动时的疼痛强度(WMD:-0.57[95%CI-1.06 至-0.08])。与对照组相比,TAP 阻滞在 24 小时内可显著减少阿片类药物的消耗,WMD 为 15.66(95%CI-23.93 至-7.39)。但 TAP 阻滞并未缩短住院时间。
结论
TAP 阻滞是缓解术后疼痛和减少术后吗啡消耗的有效方法。需要更多大样本量的 RCT 来证实这些发现。