Department of Surgery, Soba University Hospital, Khartoum, Sudan.
Department of Surgery, Soba University Hospital, Khartoum, Sudan.
J Surg Res. 2021 May;261:10-17. doi: 10.1016/j.jss.2020.12.003. Epub 2020 Dec 30.
Rectus sheath block (RSB) has been increasingly used for pain management after laparoscopic procedures but with a conflicting data on its analgesic efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RSB in adults undergoing laparoscopic surgery.
A systematic literature search of the PubMed, Embase, CINAHL, and Cochrane Library databases was conducted from inception through October 1, 2020, to identify trials comparing RSB with a control group in laparoscopic surgery. The primary outcome was rest pain scores at 0-2 h postoperatively. Secondary outcomes included pain scores at rest at 10-12 and 24 h postoperatively, pain scores on movement at 0-2, 10-12, and 24 h postoperatively, 24- and 48-h opioid consumption, opioid-related side effects, and RSB-associated adverse events.
Nine trials with 698 patients were included. RSB was associated with significantly lower rest pain scores at 0-2 h postoperatively (standardized mean difference -1.83, 95% confidence interval [-2.70, -0.96], P < 0.001, I = 95%) than control. Furthermore, RSB significantly reduced pain scores at rest at 10-12 h postoperatively and on movement at 0-2 h postoperatively, 24-h opioid consumption, and opioid-related side effects. Other secondary outcomes were similar between groups. Preoperative RSB provided better pain control compared with postoperative block administration. None of the studies reported local or systemic complications related to RSB.
In the setting of laparoscopic surgery, RSB improves pain control for up to 12 h postoperatively and reduces opioid consumption, without major reported adverse events.
腹直肌鞘阻滞（RSB）在腹腔镜手术后的疼痛管理中应用越来越多，但在其镇痛效果方面存在相互矛盾的数据。我们进行了系统评价和荟萃分析，以评估成人腹腔镜手术中 RSB 的疗效和安全性。
从成立到 2020 年 10 月 1 日，系统地检索了 PubMed、Embase、CINAHL 和 Cochrane 图书馆数据库中的文献，以确定比较 RSB 与腹腔镜手术中对照组的试验。主要结局是术后 0-2 小时的静息疼痛评分。次要结局包括术后 10-12 小时和 24 小时的静息疼痛评分、术后 0-2、10-12 和 24 小时的运动疼痛评分、24-48 小时的阿片类药物消耗、阿片类药物相关的副作用以及 RSB 相关的不良事件。
纳入了 9 项试验共 698 例患者。与对照组相比，RSB 在术后 0-2 小时的静息疼痛评分显著降低（标准化均数差 -1.83，95%置信区间 [-2.70，-0.96]，P<0.001，I=95%）。此外，RSB 还显著降低了术后 10-12 小时的静息疼痛评分和术后 0-2 小时的运动疼痛评分、24 小时阿片类药物消耗和阿片类药物相关的副作用。两组其他次要结局相似。与术后阻滞相比，术前 RSB 可提供更好的疼痛控制。研究均未报告与 RSB 相关的局部或全身并发症。
在腹腔镜手术中，RSB 可在术后 12 小时内改善疼痛控制，减少阿片类药物消耗，且无重大不良事件报告。
