Department of Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom
King's College London, London, United Kingdom.
Reg Anesth Pain Med. 2020 Nov;45(11):924-933. doi: 10.1136/rapm-2020-101726. Epub 2020 Sep 14.
Caudal block is a well-established technique for providing perioperative analgesia in pediatric genitourinary surgery, but abdominal wall blocks such as ilioinguinal-iliohypogastric (II-IH) and transversus abdominis plane (TAP) block are increasingly being used.
Our protocol for this meta-analysis was registered on PROSPERO (CRD42020163497). Central, CINAHL, Embase, Global Health, LILACS, MEDLINE, Scopus and Web of Science were searched from inception to 11 December 2019 for randomized controlled trials that included pediatric patients having genitourinary surgery with II-IH or TAP block as the intervention and caudal analgesia as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenzel method.
In all, 23 trials with 1399 patients were included. II-IH and TAP block were similar to caudal analgesia in the coprimary outcomes of the postoperative pain score at 0-2 hours (high-quality evidence) and the need for in-hospital rescue analgesia (moderate-quality evidence consequent to downgrading by publication bias). No subgroup differences in regard to the type of abdominal wall block or the method of block localization were demonstrated for these primary outcomes. Relative to caudal analgesia, II-IH and TAP block reduced the incidence of postoperative motor blockade and the time to micturition.
This meta-analysis was limited by unclear risk of selection and performance biases and significant heterogeneity. In summary, II-IH and TAP block are a non-invasive and reasonable alternative to caudal analgesia in pediatric genitourinary surgery.
骶管阻滞是小儿泌尿生殖手术围手术期镇痛的成熟技术，但腹侧壁阻滞，如髂腹股沟-髂腹下（II-IH）和腹横肌平面（TAP）阻滞，越来越多地被使用。
我们的荟萃分析方案已在 PROSPERO（CRD42020163497）上注册。从建库至 2019 年 12 月 11 日，我们对 CENTRAL、CINAHL、Embase、Global Health、LILACS、MEDLINE、Scopus 和 Web of Science 进行了检索，纳入了比较 II-IH 或 TAP 阻滞与骶管阻滞，用于小儿泌尿生殖手术的随机对照试验。对于连续性和二分类结局，我们分别使用逆方差法计算均数差，使用 Mantel-Haenzel 法计算风险比。
共纳入 23 项试验，共 1399 例患者。II-IH 和 TAP 阻滞在术后 0-2 小时疼痛评分（高质量证据）和需要院内解救镇痛（因发表偏倚而降级为中等质量证据）这两个主要结局方面与骶管阻滞相似。在这些主要结局方面，未发现腹侧壁阻滞类型或阻滞定位方法的亚组差异。与骶管阻滞相比，II-IH 和 TAP 阻滞降低了术后运动阻滞的发生率和排尿时间。
本荟萃分析受到选择和实施偏倚风险不确定以及高度异质性的限制。总之，II-IH 和 TAP 阻滞是小儿泌尿生殖手术中替代骶管阻滞的一种非侵入性且合理的选择。
