腹横肌平面阻滞与切口浸润用于剖宫产术后镇痛的效果比较：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 for post-cesarean section analgesia: A systematic review and meta-analysis of randomized controlled trials.
机构信息
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Lincoln Medical and Mental Health Center, Bronx, NY, USA.
出版信息
Int J Gynaecol Obstet. 2021 Jun;153(3):383-392. doi: 10.1002/ijgo.13563. Epub 2021 Feb 11.
BACKGROUND
Transversus abdominis plane (TAP) block and wound infiltration (WI) with local anesthetics are used for postoperative analgesia after cesarean section (CS), reducing the need for administration of opioids.
OBJECTIVE
To compare the analgesic effect of TAP block related to WI.
SEARCH STRATEGY
MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until April 2020.
SELECTION CRITERIA
Randomized controlled trials (RCTs) about women who underwent TAP block or WI after CS.
DATA COLLECTION AND ANALYSIS
Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome was cumulative opioid consumption (COC) 24 and 48 h after CS.
MAIN RESULTS
Five RCTs, enrolling 268 women, were included. There were no significant differences between the interventions regarding COC at 24 (mean difference [MD] -1.68, 95% confidence interval [CI] -6.29 to 2.93) and 48 hours (MD 1.28, 95% CI -10.44 to 13.00). Adverse effects (relative risk [RR] 0.93, 95% CI 0.75-1.16), gastrointestinal reactions (RR 1.30, 95% CI 0.46-3.68), or mild-moderate sedation (RR 1.12, 95% CI 0.72-1.74), pain scores, satisfaction of women, and withdrawals were similar between groups.
CONCLUSIONS
There might be no significant advantages selecting TAP block over WI for post-CS analgesia.
背景
腹横肌平面（TAP）阻滞和局部麻醉浸润（WI）用于剖宫产（CS）后的术后镇痛，减少了阿片类药物的使用。
目的
比较 TAP 阻滞与 WI 的镇痛效果。
检索策略
从建库到 2020 年 4 月，检索 MEDLINE、Scopus、ClinicalTrials.gov、EMBASE、Cochrane 图书馆和 CINAHL。
选择标准
关于接受 TAP 阻滞或 WI 的 CS 后妇女的随机对照试验（RCT）。
数据收集和分析
提取并制表相关数据。使用 Review Manager 5.3 进行数据分析。主要结局是 CS 后 24 和 48 小时的累积阿片类药物消耗量（COC）。
主要结果
纳入了 5 项 RCT，共 268 名女性。干预措施在 24 小时（MD -1.68，95%置信区间 [CI] -6.29 至 2.93）和 48 小时（MD 1.28，95% CI -10.44 至 13.00）的 COC 方面无显著差异。不良反应（相对风险 [RR] 0.93，95% CI 0.75-1.16）、胃肠道反应（RR 1.30，95% CI 0.46-3.68）或轻度至中度镇静（RR 1.12，95% CI 0.72-1.74）、疼痛评分、女性满意度和停药率在组间相似。
结论
在 CS 后镇痛方面，TAP 阻滞可能没有明显优于 WI。
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