腹横肌平面阻滞对肝移植患者镇痛效果的系统评价与Meta分析
The Effect of Transversus Abdominis Plane Block for Analgesia in Patients Undergoing Liver Transplantation: A Systematic Review and Meta-Analysis.
作者信息
Sharma Ankur, Goel Akhil Dhanesh, Sharma Prem Prakash, Vyas Varuna, Agrawal Sumita Pravesh
机构信息
Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
出版信息
Turk J Anaesthesiol Reanim. 2019 Oct;47(5):359-366. doi: 10.5152/TJAR.2019.60251. Epub 2019 Apr 24.
OBJECTIVE
Ultrasound-guided regional anaesthesia using transversus abdominis plane (TAP) block is a newer and safer method that can be used in patients undergoing liver transplant surgeries. This systematic review and meta-analysis was done to quantify the analgesic potential and opioid-sparing capability of TAP block in these patients.
METHODS
The studies comparing TAP-block to conventional analgesic regimens for liver transplant were searched. The studies evaluating the comparative 24-h morphine consumption during postoperative period in patients undergoing liver transplant surgeries were searched and included as the primary outcome in the analysis.
RESULTS
We found two randomised controlled trials and two retrospective studies that on meta-analysis showed that TAP block group had significantly lower requirement of morphine (WMD=27.59 mg; 95% CI: 33.47-21.70) at 24 h for pain mitigation. Also, postoperative nausea and vomiting was lower (RR=0.76; 95% CI: 0.47-1.22) but not statistically significant.
CONCLUSION
Ultrasound-guided TAP block provides postoperative analgesic efficacy in patients undergoing liver transplant surgeries. This study was registered in International prospective register of systematic reviews [PROSPERO: CRD42018094595].
目的
使用腹横肌平面（TAP）阻滞的超声引导区域麻醉是一种可用于肝移植手术患者的更新且更安全的方法。本系统评价和荟萃分析旨在量化TAP阻滞在这些患者中的镇痛潜力和节省阿片类药物的能力。
方法
检索比较TAP阻滞与肝移植常规镇痛方案的研究。检索并纳入评估肝移植手术患者术后24小时吗啡消耗量比较的研究，作为分析的主要结局。
结果
我们发现两项随机对照试验和两项回顾性研究，荟萃分析显示TAP阻滞组在24小时时缓解疼痛所需的吗啡量显著更低（加权均数差=27.59毫克；95%置信区间：33.47-21.70）。此外，术后恶心和呕吐发生率较低（风险比=0.76；95%置信区间：0.47-1.22），但无统计学意义。
结论
超声引导下的TAP阻滞为肝移植手术患者提供术后镇痛效果。本研究已在国际前瞻性系统评价注册库[PROSPERO：CRD42018094595]中注册。
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