Wei Yiyong, Li Jia, Sun Fude, Zhang Donghang, Li Ming, Zuo Yunxia
Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan.
The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu.
Medicine (Baltimore). 2020 Feb;99(9):e19323. doi: 10.1097/MD.0000000000019323.
Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate.
The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions.
Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of -0.09 (95% confidence interval (CI): -0.55-0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06-1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of -1.13(95% CI:-1.47 to 0.79) and -0.87(95% CI:-1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: -1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = -0.14 [95% CI: -0.51 to 0.23]).
Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.
低腹内压（IAP）和深度神经肌肉阻滞（NMB）常用于腹腔镜腹部手术，以改善手术空间条件并减轻术后疼痛。支持使用低IAP和深度NMB进行手术的证据尚存在争议。
研究了腹腔镜手术中常规使用低IAP+深度NMB的可行性。对随机对照试验（RCT）进行荟萃分析，以比较低IAP+深度NMB与低IAP+中度NMB、标准IAP+深度NMB以及标准IAP+中度NMB在腹腔镜手术过程中对手术空间条件、手术时长和术后疼痛的影响。使用Cochrane、Embase、PubMed和Web of Science数据库检索从建库至2019年6月的RCT。我们的检索确定了9项关于使用低IAP+深度NMB与手术空间条件的合格研究。
与使用中度NMB相比，腹腔镜手术中低IAP+深度NMB并未改善手术空间条件，平均差（MD）为-0.09（95%置信区间（CI）：-0.55-0.37）。亚组分析显示，与低IAP+中度NMB相比，使用低IAP+深度NMB可改善手术空间条件（MD = 0.63 [95% CI：0.06-1.19]），而与使用标准IAP+深度NMB和标准IAP+中度NMB相比，手术空间条件略差，MD分别为-1.13（95% CI：-1.47至0.79）和-0.87（95% CI：-1.30至0.43）。低IAP+深度NMB并未改善手术时长（MD = 1.72 [95% CI：-1.69至5.14]），且深度NMB组术后早期疼痛未显著减轻（MD = -0.14 [95% CI：-0.51至0.23]）。
在此荟萃分析中，对于优化手术空间条件、手术时长或术后疼痛，低IAP+深度NMB并不比其他IAP+NMB组合显著更有效。未来应研究腹腔镜手术后使用低IAP+深度NMB是否会减少术中并发症、提高恢复质量或两者兼具。
