腰方肌阻滞对髋关节手术患者疼痛控制的疗效：一项系统评价和Meta分析。
Efficacy of Quadratus Lumborum Block for Pain Control in Patients Undergoing Hip Surgeries: A Systematic Review and Meta-Analysis.
作者信息
Li Jinfeng, Wei Chenpu, Huang Jiangfa, Li Yuguo, Liu Hongliang, Liu Jun, Jin Chunhua
机构信息
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (The Second Clinical Medical College of Guangzhou University of Chinese Medicine), Guangzhou, China.
Applicants for Doctor Degree of Equivalent Level in Guangzhou University of Chinese Medicine, Guangzhou, China.
出版信息
Front Med (Lausanne). 2022 Feb 3;8:771859. doi: 10.3389/fmed.2021.771859. eCollection 2021.
BACKGROUND
Several studies have reported the use of anterior, posterior and lateral quadratus lumborum block (QLB) for pain control in hip surgeries. However, high-quality evidence is lacking. The current review aimed to summarize data on the efficacy of QLB for pain control in patients undergoing hip surgeries.
METHODS
PubMed, Embase, and Google Scholar databases were searched up to August 5, 2021 for randomized controlled trials (RCTs) or non-RCTs assessing the efficacy of QLB for any type of hip surgery.
RESULTS
Thirteen studies were included (nine RCTs and four non-RCTs). On pooled analysis, there was a statistically significant reduction of 24-h total opioid consumption in patients receiving QLB as compared to the control group (MD: -9.92, 95% CI: -16.35, -3.48 = 99% = 0.003). We noted a statistically significant reduction of pain scores in the QLB group as compared to control group at 2-4 h (MD: -0.57, 95% CI: -0.98, -0.17 = 61% = 0.005), 6-8 h (MD: -1.45, 95% CI: -2.09, -0.81 = 86% < 0.00001), 12 h (MD: -1.12, 95% CI: -1.89, -0.34 = 93% = 0.005), 24 h (MD: -0.71, 95% CI: -1.27, -0.15 = 89% = 0.01) and 48 h (MD: -0.76, 95% CI: -1.37, -0.16 = 85% = 0.01) after the procedure. There was a statistically significant reduction in the risk of nausea/vomiting (RR: 0.40, 95% CI: 0.18, 0.88 = 62% = 0.02) in patients receiving QLB but no difference in the risk of pruritis (RR: 0.46, 95% CI: 0.17, 1.24 = 16% = 0.13) and urinary retention (RR: 0.44, 95% CI: 0.19, 1.02 = 0% = 0.06).
CONCLUSION
QLB as a part of a multimodal analgesic regimen reduces opioid consumption and pain scores in patients undergoing hip surgeries. The certainty of evidence based on GRADE was moderate. Despite the statistically significant results, the clinical relevance of the analgesic efficacy of QLB is debatable due to the small effect size.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021267861.
背景
多项研究报告了使用腰方肌前、后和外侧阻滞（QLB）来控制髋关节手术中的疼痛。然而，缺乏高质量的证据。本综述旨在总结关于QLB在髋关节手术患者中控制疼痛疗效的数据。
方法
检索截至2021年8月5日的PubMed、Embase和谷歌学术数据库，以查找评估QLB对任何类型髋关节手术疗效的随机对照试验（RCT）或非RCT。
结果
纳入了13项研究（9项RCT和4项非RCT）。汇总分析显示，与对照组相比，接受QLB的患者24小时总阿片类药物消耗量有统计学显著降低（MD：-9.92，95%CI：-16.35，-3.48；I² = 99%；P = 0.003）。我们注意到，与对照组相比，QLB组在术后2 - 4小时（MD：-0.57，95%CI：-0.98，-0.17；I² = 61%；P = 0.005）、6 - 8小时（MD：-1.45，95%CI：-2.09，-0.81；I² = 86%；P < 0.00001）、12小时（MD：-1.12，95%CI：-1.89，-0.34；I² = 93%；P = 0.005）、24小时（MD：-0.71，95%CI：-1.27，-0.15；I² = 89%；P = 0.01）和48小时（MD：-0.76，95%CI：-1.37，-0.16；I² = 85%；P = 0.01）时疼痛评分有统计学显著降低。接受QLB的患者恶心/呕吐风险有统计学显著降低（RR：0.40，95%CI：0.18，0.88；I² = 62%；P = 0.02），但瘙痒风险（RR：0.46，95%CI：0.17，1.24；I² = 16%；P = 0.13）和尿潴留风险（RR：0.44，95%CI：0.19，1.02；I² = 0%；P = 0.06）无差异。
结论
QLB作为多模式镇痛方案的一部分，可降低髋关节手术患者的阿片类药物消耗量和疼痛评分。基于GRADE的证据确定性为中等。尽管结果有统计学显著性，但由于效应量小，QLB镇痛效果的临床相关性仍有争议。
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