University of Florida College of Medicine, Gainesville, FL.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida Health, Gainesville, FL.
Aesthet Surg J. 2020 Oct 24;40(11):1208-1215. doi: 10.1093/asj/sjz313.
A variety of regional nerve blocks have been utilized in abdominoplasty procedures, including transversus abdominis plane (TAP), intercostal, rectus sheath (RS), pararectus + ilioinguinal/iliohypogastric, quadratus lumborum, and paravertebral blocks. No consensus exists regarding the most effective nerve block modality in optimizing postprocedural comfort levels.
The purpose of this systematic review was to explore the efficacy of the various abdominal nerve blocks employed in abdominoplasty surgery and to draw attention to any modality that may be superior in regards to effectiveness and/or administration.
Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed to identify studies that have employed regional nerve blocks in abdominoplasty procedures. Opioid consumption, pain scores, time to ambulation, time in the recovery room, and time to first analgesia request were extracted when available.
A total of 191 articles were reviewed, of which 8 met inclusion criteria. The nerve blocks represented included TAP, RS, pararectus + ilioinguinal/iliohypogastric, intercostal, and quadratus lumborum. All modalities were effective in reducing opioid consumption except quadratus lumborum.
TAP, RS, pararectus + ilioinguinal/iliohypogastric, and intercostal regional nerve blocks have been shown to optimize postoperative pain management in abdominoplasty procedures. The existing literature suggests that when studied against one another, TAP is more efficacious than RS and pararectus + ilioinguinal/iliohypogastric. When ultrasound guidance is unavailable, consideration should be given to TAP employing the direct visualization approach.
在腹部整形手术中，已经使用了多种区域神经阻滞，包括腹横肌平面（TAP）、肋间、腹直肌鞘（RS）、腹直肌旁+髂腹股沟/髂腹下、竖脊肌和椎旁阻滞。关于哪种神经阻滞方式最能有效优化术后舒适度，目前尚无共识。
本系统评价的目的是探讨腹部整形手术中使用的各种腹部神经阻滞的疗效，并提请注意任何在有效性和/或管理方面可能更优越的方式。
根据系统评价和荟萃分析的首选报告项目指南，进行了系统评价，以确定在腹部整形手术中使用区域神经阻滞的研究。在可行的情况下，提取了阿片类药物消耗、疼痛评分、下床时间、恢复室时间和首次镇痛请求时间。
共回顾了 191 篇文章，其中 8 篇符合纳入标准。所代表的神经阻滞包括 TAP、RS、腹直肌旁+髂腹股沟/髂腹下、肋间和竖脊肌。除了竖脊肌外，所有方式都能有效减少阿片类药物的消耗。
TAP、RS、腹直肌旁+髂腹股沟/髂腹下和肋间区域神经阻滞已被证明能优化腹部整形手术后的疼痛管理。现有文献表明，在相互比较时，TAP 比 RS 和腹直肌旁+髂腹股沟/髂腹下更有效。在无法使用超声引导的情况下，应考虑采用直接可视化方法进行 TAP。
