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关于腹横肌平面阻滞对腹腔镜胆囊切除术后疼痛控制效果的随机对照试验的Meta分析

A Meta-Analysis of Randomized Controlled Trials Concerning the Efficacy of Transversus Abdominis Plane Block for Pain Control After Laparoscopic Cholecystectomy.

作者信息

Wang Weihua, Wang Lishan, Gao Yan

机构信息

Department of Thoracic Surgery, Weifang Second People's Hospital, Weifang, China.

Department of Oral and Maxillofacial Surgery, Weifang Second People's Hospital, Weifang, China.

出版信息

Front Surg. 2021 Aug 4;8:700318. doi: 10.3389/fsurg.2021.700318. eCollection 2021.

Abstract

Transverse abdominis plane (TAP) block has been suggested to reduce post-operative pain after laparoscopic cholecystectomy (LC). However, the literature is divided on whether ultrasound (USG)-guided TAP block is effective for pain control after LC. The present meta-analysis therefore evaluated the efficacy of USG-guided TAP block vs. controls and port site infiltration for pain control after LC. A comprehensive literature search of online academic databases was performed for published randomized controlled trials (RCTs) for studies published to January 31, 2021. The primary outcome analyzed was post-operative pain score at 0, 6, 12, and 24 h post-surgery, both during rest and while coughing. Secondary outcomes included morphine consumption and post-operative nausea and vomiting (PONV) incidence. A total of 23 studies with data on 1,450 LC patients were included in our meta-analysis. A reduction in pain intensity at certain post-operative timepoints was observed for USG-guided TAP block patients compared to control group patients. No reduction in pain intensity was observed for patients receiving USG-guided TAP block patients vs. conventional Port site infiltration. This meta-analysis concludes that TAP block is more effective than a conventional pain control, but not significatively different from another local incisional pain control that is port site infiltration. Additional prospective randomized controlled trials are required to further validate our findings.

摘要

有人提出腹横肌平面(TAP)阻滞可减轻腹腔镜胆囊切除术(LC)后的术后疼痛。然而,关于超声(USG)引导下的TAP阻滞对LC术后疼痛控制是否有效,文献观点不一。因此,本荟萃分析评估了USG引导下的TAP阻滞与对照组及切口浸润用于LC术后疼痛控制的疗效。对在线学术数据库进行了全面的文献检索,以查找截至2021年1月31日发表的关于随机对照试验(RCT)的研究。分析的主要结局是术后0、6、12和24小时休息及咳嗽时的术后疼痛评分。次要结局包括吗啡用量及术后恶心呕吐(PONV)发生率。我们的荟萃分析共纳入了23项涉及1450例LC患者数据的研究。与对照组患者相比,观察到USG引导下的TAP阻滞患者在术后特定时间点的疼痛强度有所降低。接受USG引导下的TAP阻滞患者与接受传统切口浸润的患者相比,疼痛强度未降低。本荟萃分析得出结论,TAP阻滞比传统的疼痛控制更有效,但与另一种局部切口疼痛控制即切口浸润无显著差异。需要更多前瞻性随机对照试验来进一步验证我们的研究结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3404/8371254/4bff94da258e/fsurg-08-700318-g0001.jpg

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