腹横肌平面阻滞与局部麻醉浸润用于剖宫产术后镇痛的效果比较：一项系统评价和荟萃分析，包含试验序贯分析。

Transversus abdominis plane block versus local anaesthetic wound infiltration for analgesia after caesarean section: A systematic review and meta-analysis with trial sequential analysis.

机构信息

From the Department of Anaesthesia, Valais Hospital, Sion (SG), University of Lausanne, Lausanne, Switzerland (SG), Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada (KRK) and Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland (EA).

出版信息

Eur J Anaesthesiol. 2022 Mar 1;39(3):244-251. doi: 10.1097/EJA.0000000000001552.

DOI:10.1097/EJA.0000000000001552

PMID:34091477

Abstract

BACKGROUND

Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section.

OBJECTIVES

To determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section.

DESIGN

Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science up to June 2020.

ELIGIBILITY CRITERIA

We retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity.

RESULTS

Seven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate.

CONCLUSION

There is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section.

TRIAL REGISTRY NUMBER

PROSPERO CRD42020208046.

摘要

背景

腹横肌平面（TAP）阻滞和局部麻醉伤口浸润用于缓解剖宫产术后疼痛。

目的

确定 TAP 阻滞或局部麻醉伤口浸润在剖宫产术后哪种是更好的镇痛选择。

设计

系统评价和荟萃分析，结合试验序贯分析。

数据来源

MEDLINE、Embase、Cochrane 对照试验中心注册库、Web of Science 截至 2020 年 6 月。

入选标准

我们检索了比较 TAP 阻滞与剖宫产术后伤口浸润的随机对照试验。主要结局是术后 2 小时静息时疼痛评分（模拟量表，0 至 10），根据 TAP 阻滞技术（超声引导/地标引导）、麻醉策略（脊髓/全身）、鞘内芬太尼（是/否）和多模式镇痛（是/否）进行分析。次要疼痛相关结局包括术后 12 小时和 24 小时静息时的疼痛评分以及术后 2 小时、12 小时和 24 小时的静脉吗啡总消耗量。我们评估了阻滞并发症的发生率，包括术后感染、血肿、内脏损伤和局部麻醉全身毒性。

结果

确定了 7 项试验，共计 475 名患者。两组患者在 2 小时静息时的疼痛评分无差异。亚组分析显示，TAP 阻滞技术（P=0.64）、麻醉策略（P=0.53）、鞘内芬太尼的使用（P=0.59）或多模式镇痛的存在（P=0.57）均无差异。两组在术后 12 小时静息时的疼痛评分和术后 2 小时和 12 小时的静脉吗啡消耗量相同。数据不足以比较阻滞并发症。总体证据质量为中等。