腹横肌平面阻滞与常规局麻药浸润用于成人手术患者的效果比较：一项随机对照试验的系统评价和荟萃分析。

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

机构信息

Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China.

Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China.

出版信息

Biomed Res Int. 2020 Mar 23;2020:8914953. doi: 10.1155/2020/8914953. eCollection 2020.

BACKGROUND

How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. . A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores.

RESULTS

Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference = -0.32, 95% confidence interval (-0.87, 0.24), = 0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction.

CONCLUSION

TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.

背景

如何有效控制患者的术后疼痛对临床医生来说至关重要。腹横肌平面（TAP）阻滞是一种新的镇痛方法，据报道可大大减轻术后疼痛。然而，在许多地区，由于传统观念或便利性，仍存在外科医生使用常规局部麻醉剂（非脂质体麻醉剂）进行伤口浸润（WI）作为主要手段来减轻术后疼痛的现象。在这里，我们比较了两种不同方法的镇痛效果，以确定哪种方法更适合成年患者。

方法

对比较 TAP 阻滞和无脂质体麻醉剂的 WI 在成年患者中的镇痛效果的随机对照试验（RCT）进行了系统评价和荟萃分析。广泛搜索了常用数据库。主要结局是不同情况下（休息时或运动时）的术后疼痛评分和首次使用解救性镇痛药物的时间。次要结局是术后恶心和呕吐（PONV）发生率和患者满意度评分。

结果

纳入了 15 项研究，共 983 名参与者，符合纳入标准。最终分析中疼痛评分的异质性为低至中度。敏感性分析的主要结果稳定。WI 与 TAP 阻滞的镇痛效果相同，仅在术后 1 小时（平均差异=-0.32，95%置信区间[-0.87，0.24]，=0.26），与首次使用解救性镇痛药物的时间更短和患者满意度更差相关。