Huang Jia-Yu, Wang Li-Zhong, Chang Xiang-Yang, Xia Feng
Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang Province, China.
Clin J Pain. 2021 Dec 17;38(3):231-239. doi: 10.1097/AJP.0000000000001014.
Intrathecal morphine (ITM) is frequently associated with side effects such as postoperative nausea and vomiting (PONV) and pruritus. The aim of this meta-analysis was to compare the impact of transversus abdominis plane (TAP) block versus ITM on side effects following cesarean delivery.
PubMed, Embase, Web of Science, and CENTRAL were searched for randomized controlled trials that compared TAP with ITM for cesarean delivery. The primary outcomes were opioid-related side effects. The secondary outcomes included pain scores, opioid consumption, patient satisfaction, and time to the first analgesia request.
Seven studies involving 660 patients were included. TAP blocks were performed with bupivacaine or ropivacaine. There was less PONV with TAP versus ITM (risk ratio [RR]=0.45, 95% confidence interval [CI]: 0.33-0.63, P<0.001; I2=0%), but no significant difference in pruritus (RR=0.76, 95% CI: 0.49-1.18, P=0.22; I2=78%) and sedation (RR=0.44, 95% CI: 0.19-1.00, P=0.05; I2=0%). TAP had a greater morphine consumption in 24 hours (mean difference: 5.80 mg; 95% CI: 1.38-10.22 mg, P=0.01; I2=89%) and higher pain score at rest at 6 hours (mean difference: 0.70, 95% CI: 0.39-1.02, P<0.001; I2=56%), but similar pain at rest at 24 hours and on movement compared with ITM. No differences were found in time to first analgesia and patient satisfaction.
Compared with ITM, TAP block is associated with less PONV but inferior early analgesia after cesarean delivery. However, the heterogeneity among the studies highlights the need for more well-designed studies to obtain more robust conclusions.
鞘内注射吗啡（ITM）常伴有诸如术后恶心呕吐（PONV）和瘙痒等副作用。本荟萃分析的目的是比较腹横肌平面（TAP）阻滞与ITM对剖宫产术后副作用的影响。
检索了PubMed、Embase、Web of Science和CENTRAL数据库，查找比较TAP与ITM用于剖宫产的随机对照试验。主要结局为阿片类药物相关副作用。次要结局包括疼痛评分、阿片类药物用量、患者满意度以及首次要求镇痛的时间。
纳入了7项涉及660例患者的研究。TAP阻滞采用布比卡因或罗哌卡因。与ITM相比，TAP阻滞导致的PONV更少（风险比[RR]=0.45，95%置信区间[CI]：0.33 - 0.63，P<0.001；I²=0%），但在瘙痒（RR=0.76，95% CI：0.49 - 1.18，P=0.22；I²=78%）和镇静方面无显著差异（RR=0.44，95% CI：0.19 - 1.00，P=0.05；I²=0%）。TAP在24小时内的吗啡用量更多（平均差值：5.80 mg；95% CI：1.38 - 10.22 mg，P=0.01；I²=89%），且在6小时静息时疼痛评分更高（平均差值：·70，95% CI：0.39 - 1.02，P<0.001；I²=56%），但与ITM相比，在24小时静息及活动时的疼痛程度相似。在首次要求镇痛的时间和患者满意度方面未发现差异。
与ITM相比，TAP阻滞与较少的PONV相关，但剖宫产术后早期镇痛效果较差。然而，研究之间的异质性凸显了需要更多设计良好的研究以得出更可靠结论的必要性。
