College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States; Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
J Gynecol Obstet Hum Reprod. 2021 Oct;50(8):102077. doi: 10.1016/j.jogoh.2021.102077. Epub 2021 Feb 3.
To perform a systematic review and meta-analysis of all randomized controlled trials that examined the efficacy of intraoperative local injection of the uterosacral ligaments with ropivacaine on postoperative pain and opioids consumption in patients undergoing uterine surgery for hysterectomy/myomectomy.
PubMed, Scopus, Web of Science and Cochrane Library databases were screened from inception to September 5th, 2020. We appraised the risk of bias using the Cochrane's risk of bias tool. Resting postoperative pain scores and cumulative consumption of postoperative opioids were regarded as continuous data, analyzed using the inverse variance method and reported as standardized mean difference (SMD) and weighted mean difference (MD), respectively, with 95 % confidence intervals (95 % CIs).
Five studies met the inclusion criteria comprising 230 patients (117 and 113 patients received ropivacaine and placebo, respectively). The studies had an overall low risk of bias. Resting postoperative pain scores were not significantly different between both groups at 2 h (SMD = -0.30, 95 % CI [-0.70, 0.11], p = 0.15), 12 h (SMD = 0.04, 95 % CI [-0.26, 0.37], p = 0.81) and 24 h (SMD = -0.06, 95 % CI [-0.32, 0.20], p = 0.68). However, the ropivacaine group had significantly reduced cumulative opioid consumption during the first 24 h postoperatively (MD = -9.07, 95 % CI [-14.47, -3.66], p = 0.001).
Intraoperative local infiltration of uterosacral ligaments with ropivacaine is technically feasible and significantly reduces postoperative opioid consumption in women undergoing gynecologic surgery of the uterus.
系统评价和荟萃分析所有随机对照试验，以评估罗哌卡因局部注射子宫骶韧带在子宫切除术/子宫肌瘤切除术中对术后疼痛和阿片类药物消耗的疗效。
从建立到 2020 年 9 月 5 日，我们对 PubMed、Scopus、Web of Science 和 Cochrane Library 数据库进行了筛选。我们使用 Cochrane 偏倚风险工具评估了偏倚风险。静息术后疼痛评分和术后阿片类药物累积消耗量被视为连续数据，使用逆方差法进行分析，并分别报告为标准化均数差（SMD）和加权均数差（MD），置信区间（95%CI）为 95%。
五项研究符合纳入标准，共纳入 230 例患者（分别有 117 例和 113 例患者接受罗哌卡因和安慰剂治疗）。这些研究的总体偏倚风险较低。两组在 2 小时（SMD=-0.30，95%CI[-0.70，0.11]，p=0.15）、12 小时（SMD=0.04，95%CI[-0.26，0.37]，p=0.81）和 24 小时（SMD=-0.06，95%CI[-0.32，0.20]，p=0.68）时静息术后疼痛评分无显著差异。然而，罗哌卡因组在术后 24 小时内的阿片类药物累积消耗量明显减少（MD=-9.07，95%CI[-14.47，-3.66]，p=0.001）。
罗哌卡因局部子宫骶韧带浸润在技术上是可行的，并显著减少了接受妇科子宫手术的女性术后阿片类药物的消耗。
