Daghmouri Mohamed Aziz, Chaouch Mohamed Ali, Oueslati Maroua, Rebai Lotfi, Oweira Hani
Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia.
Department of Visceral Surgery, Fattouma Bourguiba Hospital, University of Monastir, Tunisia.
Ann Med Surg (Lond). 2021 Dec 1;72:103124. doi: 10.1016/j.amsu.2021.103124. eCollection 2021 Dec.
Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients.
We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine.
Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia.
Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228).
疼痛管理是腹腔镜结肠切除术后加速康复外科（ERAS）的一个重要组成部分。人们提出了多种区域和神经轴技术，但其疗效仍存在争议。本系统评价评估了已发表的关于镇痛技术及其对腹腔镜结肠手术患者术后镇痛和恢复影响的证据。
我们于2021年5月10日通过PubMed、Cochrane数据库和谷歌学术进行了文献研究。我们纳入了荟萃分析和随机临床试验。我们根据牛津循证医学中心对临床数据的强度和后续建议进行了分级。
共纳入12项研究。胸段硬膜外镇痛可改善腹腔镜结肠切除术后的镇痛效果和肠道功能。然而，它会延长住院时间。腹横肌平面阻滞在疼痛控制方面与胸段硬膜外镇痛效果相当，但术后恢复更好，住院时间更短。此外，利多卡因静脉输注改善了术后疼痛管理和恢复；腰方肌阻滞提供了相似的术后镇痛和恢复效果。最后，伤口浸润可减轻术后疼痛，但不能改善肠道功能恢复，可作为胸段硬膜外镇痛的替代方法。
已经对几种镇痛技术进行了研究。我们发现腹壁阻滞在疼痛管理方面与胸段硬膜外镇痛效果相当，但住院时间更短，恢复更好。我们已在PROSPERO（注册号：CRD42021279228）上注册了本评价。
