Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea.
Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
J Clin Anesth. 2021 Dec;75:110560. doi: 10.1016/j.jclinane.2021.110560. Epub 2021 Oct 19.
This study aimed to identify the benefits of quadratus lumborum block (QLB) in terms of postoperative analgesic effects in adult participants undergoing hip surgery.
Meta-analysis of randomized controlled trials.
Previous randomized controlled trials that evaluated the analgesic effect of QLB compared to that of no block.
Nine studies including 616 participants.
Participants in the treatment group received QLB, whereas those in the control group received no block.
Outcomes were postoperative 24-h opioid consumption (primary), 12-h/24-h visual analog scale (VAS) or numeric rating scale (NRS) pain scores, postoperative nausea and vomiting (PONV), and satisfaction. The effect size was estimated using the standardized mean difference (SMD), mean difference (MD), or risk ratio (RR) with a 95% confidence interval (CI). We used the risk of bias tool (RoB 2) to assess the risk of bias of the included studies and the GRADE approach to determine the level of certainty of the evidence.
Compared to no block, the QLB group has less opioid consumption (SMD -1.69, 95% CI -2.54 to -0.84; low level of certainty of the evidence). Estimated MD for morphine consumption was 24 mg. The QLB group had a lower 12-h VAS/NRS pain score (MD -1.16, 95% CI -1.82 to -0.51; moderate level of certainty of the evidence) and 24-h VAS/NRS pain score (MD -0.92, 95% CI -1.42 to -0.43; moderate level of certainty of the evidence). QLB decreased the incidence of PONV (RR 0.43, 95% CI 0.24 to 0.79; moderate level of certainty of the evidence) and increased participants' satisfaction (SMD 1.15, 95% CI 0.63 to 1.67; moderate level of certainty of the evidence). Estimated MD for satisfaction was 1.74 points of Likert scale. There were no significant adverse events associated with the QLB in any of the included trials.
Our meta-analysis showed that QLB when compared to no block clinically decreased opioid requirements, reduced PONV, and improved participants' satisfaction. QLB also seems to be significantly superior to no block in terms of pain score, but its clinical importance remains unclear.
本研究旨在探讨腹横肌平面阻滞（QLB）在成人髋关节手术后的镇痛效果。
随机对照试验的荟萃分析。
评估 QLB 镇痛效果与无阻滞效果的先前随机对照试验。
9 项研究共 616 名参与者。
治疗组接受 QLB，对照组未接受阻滞。
术后 24 小时阿片类药物消耗（主要）、12 小时/24 小时视觉模拟评分（VAS）或数字评分量表（NRS）疼痛评分、术后恶心和呕吐（PONV）和满意度。使用标准化均数差（SMD）、均数差（MD）或风险比（RR）及其 95%置信区间（CI）估计效应大小。我们使用偏倚风险工具（RoB 2）评估纳入研究的偏倚风险，并使用 GRADE 方法确定证据的确定性水平。
与无阻滞相比，QLB 组阿片类药物消耗减少（SMD-1.69，95%CI-2.54 至-0.84；证据确定性水平低）。估计吗啡消耗量的 MD 为 24mg。QLB 组 12 小时 VAS/NRS 疼痛评分（MD-1.16，95%CI-1.82 至-0.51；证据确定性水平中等）和 24 小时 VAS/NRS 疼痛评分（MD-0.92，95%CI-1.42 至-0.43；证据确定性水平中等）较低。QLB 降低了 PONV 的发生率（RR0.43，95%CI0.24 至 0.79；证据确定性水平中等），并提高了参与者的满意度（SMD1.15，95%CI0.63 至 1.67；证据确定性水平中等）。估计满意度的 MD 为 1.74 分的 Likert 量表。在所有纳入的试验中，QLB 均未出现与 QLB 相关的任何不良事件。
我们的荟萃分析表明，与无阻滞相比，QLB 可降低阿片类药物需求，减少 PONV，并提高患者满意度。在疼痛评分方面，QLB 似乎明显优于无阻滞，但临床重要性尚不清楚。
