Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Colon and Rectal Surgery Associates, Department of Surgery, University of Minnesota, St. Paul, Minnesota.
Dis Colon Rectum. 2019 Oct;62(10):1248-1255. doi: 10.1097/DCR.0000000000001464.
Multimodal analgesia is important for postoperative recovery in laparoscopic colorectal surgery. Multiple randomized controlled trials have investigated the use of transversus abdominis plane local anesthetic infiltration as a method of decreasing postoperative pain and opioid consumption, with variable results.
This study aimed to examine the overall effect of transversus abdominis plane block in postoperative pain, opioid use, and speed of recovery in laparoscopic colorectal surgery.
A literature search was done with PubMed, EMBASE, Web of Knowledge, and Cochrane Library. Only randomized controlled trials were selected for review.
Transversus abdominis plane local anesthetic infiltration versus no intervention, saline, or other techniques in laparoscopic colorectal surgeries was investigated.
The primary outcome measured was postoperative pain on day 1, at rest or with activity. The secondary outcomes measured were postoperative pain beyond day 1, consumptions of opioid, and length of hospital stay.
Eight clinical trials including 649 patients between 2013 and 2018 were included. Resting pain scores within 2 hours (standardized mean difference, -0.53; p = 0.01), 4 hours (standardized mean difference, -0.42; p = 0.004), and 6 hours (standardized mean difference, -0.47; p = 0.03) showed statistically significant reduction. Six studies including 413 patients demonstrated lower cumulative opioid consumption within 24 hours after surgery (standardized mean difference, -0.82; p = 0.01). Five studies including 357 patients did not show a significant difference in length of stay (standardized mean difference, -0.04; p = 0.82).
Local anesthetic used in block varied in type and quantity across different studies. There were heterogeneities in pain score measurements and opioid consumption. Patient populations may be different among studies.
Transversus abdominis block can lead to a lower pain score at rest within the first 6 hours and reduce opioid consumption within the first 24 hours. See Video Abstract at http://links.lww.com/DCR/A997.
多模式镇痛对于腹腔镜结直肠手术后的康复很重要。多项随机对照试验已经研究了腹横肌平面局部麻醉浸润作为减少术后疼痛和阿片类药物消耗的方法，结果各不相同。
本研究旨在检查腹横肌平面阻滞在腹腔镜结直肠手术后的总体效果，包括术后疼痛、阿片类药物使用和恢复速度。
通过 PubMed、EMBASE、Web of Knowledge 和 Cochrane Library 进行文献检索。仅选择随机对照试验进行综述。
腹横肌平面局部麻醉浸润与腹腔镜结直肠手术中的无干预、生理盐水或其他技术进行比较。
主要观察指标为术后第 1 天的静息或活动时的疼痛。次要观察指标为术后第 1 天以后的疼痛、阿片类药物消耗和住院时间。
纳入了 2013 年至 2018 年的 8 项临床试验，共 649 例患者。术后 2 小时（标准化均数差，-0.53；p = 0.01）、4 小时（标准化均数差，-0.42；p = 0.004）和 6 小时（标准化均数差，-0.47；p = 0.03）的静息疼痛评分显示有统计学意义的降低。6 项研究（共 413 例患者）显示术后 24 小时内累积阿片类药物消耗减少（标准化均数差，-0.82；p = 0.01）。5 项研究（共 357 例患者）在住院时间方面无显著差异（标准化均数差，-0.04；p = 0.82）。
不同研究中使用的阻滞局部麻醉的类型和数量不同。疼痛评分测量和阿片类药物消耗存在异质性。患者人群在不同研究中可能不同。
腹横肌平面阻滞可使术后 6 小时内静息时疼痛评分降低，并减少术后 24 小时内阿片类药物的消耗。
