罗哌卡因与布比卡因用于小儿腹部手术后腹直肌鞘阻滞的镇痛效果比较：随机对照试验和回顾性队列研究的荟萃分析。

Comparative Analgesic Efficacies of Ropivacaine and Bupivacaine for Postoperative Rectus Sheath Block in Paediatric Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trial and Retrospective Cohort Studies.

机构信息

Department of General Medicine, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan.

Department of General Medicine, Mackay Memorial Hospital, Taipei, Taiwan.

出版信息

Pain Res Manag. 2021 Mar 15;2021:5535730. doi: 10.1155/2021/5535730. eCollection 2021.

BACKGROUND

The optimal dose and concentration of analgesic efficacy of ropivacaine (RPV) and bupivacaine (BPV) for postoperative pain relief in paediatric abdominal surgery patients is still unclear. Therefore, this meta-analysis compared the efficacy of these analgesics, their administered modes (ultrasound-guided RSB versus LAI) for postoperative pain relief, and side effects.

METHODS

Three databases, PubMed, Embase, and Cochrane Database of Systematic Reviews, were exhaustively searched with predefined keywords. Eight randomized clinical trials and retrospective studies were selected. Analgesic effect, postoperative pain score, level of side effect, applied dose, and concentration of drug were analysed.

RESULTS

Drug dose ranged from 0.5-2.5 mL/kg of 0.2 to 0.5% concentrations. Male participant for RSB and LAI treatment groups varied from 40-62% and 25-83%, respectively. Mean age of RSB and LAI groups ranged from 3.8-11.65 years and 4.3-11.27 years, respectively. Our meta-analysis revealed that RSB could reduce total opioid use postoperatively (WMD = -0.02, 95% CI: -0.02, -0.02), with value of 15%. We found that the RPV (0.25%, 2.5 ml/kg) was optimal in suppressing the pain. Its lower concentration (0.2%) was ineffective, whereas higher one (0.375%) seems to increase risk of systemic toxicity. Similarly, BPV (0.25%, 2.5 mg/kg) efficaciously reduced the pain score, while its lower concentration was ineffective. The combined postoperative pain score in the RPV-treated group was found to be significantly reduced ( < 0.01) with value of 85% indicating high heterogeneity.

CONCLUSION

Both RPV and BPV were significantly effective in reducing postoperative pain score. It appears that RSB could be a preferred choice to deliver analgesia, due to reduced opiate dose requirement and improved clinical safety without significant postoperative adverse events.

背景

罗哌卡因（RPV）和布比卡因（BPV）用于小儿腹部手术后缓解疼痛的最佳剂量和浓度仍不清楚。因此，本荟萃分析比较了这些镇痛剂的疗效、用于术后镇痛的给药方式（超声引导直肠给药与局部麻醉）以及副作用。

方法

使用预定义的关键词，全面搜索了 PubMed、Embase 和 Cochrane 系统评价数据库。选择了 8 项随机临床试验和回顾性研究。分析了镇痛效果、术后疼痛评分、副作用水平、药物应用剂量和浓度。

结果

药物剂量范围为 0.5-2.5ml/kg 的 0.2-0.5%浓度。RSB 和 LAI 治疗组的男性参与者分别为 40-62%和 25-83%。RSB 和 LAI 组的平均年龄分别为 3.8-11.65 岁和 4.3-11.27 岁。我们的荟萃分析显示，RSB 可以减少术后总阿片类药物用量（WMD=-0.02，95%CI：-0.02，-0.02），值为 15%。我们发现 RPV（0.25%，2.5ml/kg）在抑制疼痛方面效果最佳。其较低浓度（0.2%）无效，而较高浓度（0.375%）似乎会增加全身毒性风险。同样，BPV（0.25%，2.5mg/kg）有效地降低了疼痛评分，而其较低浓度则无效。RPV 治疗组的联合术后疼痛评分明显降低（<0.01），值为 85%，表明存在高度异质性。