Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
Minerva Anestesiol. 2020 May;86(5):554-564. doi: 10.23736/S0375-9393.20.13975-0. Epub 2020 Jan 30.
This study aimed to evaluate the effect of quadratus lumborum (QL) block on pain after surgeries under general or spinal anesthesia.
A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to compare pain scores at rest and with movement 48 h postoperatively in a QL block group and a control group both with placebo block and without block and the time to first additional analgesics. The analgesic effect of the QL block according to the type of surgery and block approach was also examined. A literature search was performed using well-known databases for articles published up to March 2019.
Nine RCTs were included. Compared to the control group, pain scores at rest were significantly lower for 48 h postoperatively in the QL block group. QL block reduced pain scores with movement at six, 12, and 24 h postoperatively. The QL block group exhibited the most improved numerical pain scores at 12 h postoperatively both at rest and with movement, with a mean difference (MD) of -2.16 (95% confidence interval [CI] -3.12 to -1.20) and -2.26 [95% CI -3.54 to -0.98]), respectively. The subgroup analysis of pain scores at rest showed a statistically significant subgroup difference (P=0.02, I2=75.7%), suggesting a different analgesic effect of QL block based on the approach. Time to first additional analgesics postoperatively was longer in the QL block group than in the control group (MD 333.51 minutes [95% CI 69.37 to 597.64]).
QL block may be a good multimodal analgesic approach for pain after abdominal surgeries.
本研究旨在评估腹横肌（QL）阻滞对全身麻醉或椎管内麻醉下手术后疼痛的影响。
进行了系统评价和随机对照试验（RCT）的荟萃分析，以比较 QL 阻滞组和对照组在术后 48 小时的静息和运动时的疼痛评分，对照组为安慰剂阻滞和无阻滞，以及首次使用额外镇痛药物的时间。还检查了 QL 阻滞根据手术类型和阻滞方法的镇痛效果。文献检索使用了著名的数据库，检索截至 2019 年 3 月发表的文章。
纳入了 9 项 RCT。与对照组相比，QL 阻滞组在术后 48 小时的静息时疼痛评分显著降低。QL 阻滞在术后 6、12 和 24 小时时减轻了运动时的疼痛评分。QL 阻滞组在术后 12 小时时静息和运动时的数字疼痛评分均有显著改善，平均差值（MD）分别为-2.16（95%置信区间[CI] -3.12 至 -1.20）和-2.26 [95% CI -3.54 至 -0.98]）。静息时疼痛评分的亚组分析显示，统计学上存在显著的亚组差异（P=0.02，I2=75.7%），表明 QL 阻滞的镇痛效果基于方法不同。QL 阻滞组术后首次使用额外镇痛药物的时间长于对照组（MD 333.51 分钟[95% CI 69.37 至 597.64]）。
QL 阻滞可能是腹部手术后疼痛的一种良好的多模式镇痛方法。
