Lin Cheng, Wang Xuemei, Qin Chaosheng, Liu Jingchen
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, People's Republic of China.
Ther Clin Risk Manag. 2022 Mar 29;18:299-313. doi: 10.2147/TCRM.S349494. eCollection 2022.
The quadratus lumborum block provides postoperative analgesia for patients undergoing abdominal surgery, although there are three common approaches to perform this block. The present meta-analysis investigated the effectiveness of posterior quadratus lumborum block (QLB2) after surgery.
PubMed, Embase, and the Cochrane Central Register were searched from inception to 26 August 2021 for randomized controlled trials that evaluated the analgesic efficacy of QLB2 vs control (placebo or no block). The primary outcomes were pain scores at 6 h, 12 h, and 24 h after surgery. The secondary outcomes were morphine consumption at 24 h after surgery and the postoperative complications.
The present meta-analysis included 14 studies conducted with a total of 1001 patients. In comparison to control group, the QLB2 group presented significantly lower rest pain scores at 6 h (SMD -0.59; 95% CI: -1.05, -0.12; p = 0.01, I = 84%; GRADE = moderate), 12 h (SMD: -0.83; 95% CI: -1.47, -0.19; p = 0.01; I = 88%; GRADE = low), and 24 h (SMD: -0.37; 95% CI: -0.71, -0.03; p = 0.03; I = 80%; GRADE = moderate) after surgery. The dynamic pain scores were significantly reduced, compared to control, in the QLB2 group at 12 h (SMD: -0.93; 95% CI: -1.52, -0.33; p = 0.002; I = 83%; GRADE = low) and 24 h (SMD: -0.52; 95% CI: -0.93, -0.11; p = 0.01; I = 83%; GRADE = moderate) after surgery. In addition, the QLB2 group presented reduced postoperative opioid consumption at 24 h (SMD: -0.45; 95% CI: -0.86, -0.03; p = 0.03; I = 78%; GRADE = moderate). The subgroup analyses revealed that the analgesic benefit of QLB2 did not persist beyond 24 h when the patients were under spinal anesthesia.
Ultrasound-guided QLB2 could provide effective analgesia for patients under general anesthesia by decreasing the intensity of pain and opioid requirement when used within 24 h after abdominal surgery.
腰方肌阻滞可为接受腹部手术的患者提供术后镇痛，尽管有三种常用的方法来实施这种阻滞。本荟萃分析研究了术后腰方肌后路阻滞（QLB2）的有效性。
检索了PubMed、Embase和Cochrane中央注册库，时间范围从建库至2021年8月26日，以查找评估QLB2与对照组（安慰剂或未阻滞）镇痛效果的随机对照试验。主要结局为术后6小时、12小时和24小时的疼痛评分。次要结局为术后24小时的吗啡消耗量和术后并发症。
本荟萃分析纳入了14项研究，共1001例患者。与对照组相比，QLB2组在术后6小时（标准化均数差[SMD] -0.59；95%置信区间[CI]：-1.05，-0.12；p = 0.01，I² = 84%；推荐等级[GRADE] = 中等）、12小时（SMD：-0.83；95% CI：-1.47，-0.19；p = 0.01；I² = 88%；GRADE = 低）和24小时（SMD：-0.37；95% CI：-0.71，-0.03；p = 0.03；I² = 80%；GRADE = 中等）的静息疼痛评分显著更低。与对照组相比，QLB2组在术后12小时（SMD：-0.93；95% CI：-1.52，-0.33；p = 0.002；I² = 83%；GRADE = 低）和24小时（SMD：-0.52；95% CI：-0.93，-0.11；p = 0.01；I² = 83%；GRADE = 中等）的动态疼痛评分显著降低。此外，QLB2组在术后24小时的阿片类药物消耗量减少（SMD：-0.45；95% CI：-0.86，-0.03；p = 0.03；I² = 78%；GRADE = 中等）。亚组分析显示，当患者接受脊髓麻醉时，QLB2的镇痛益处不会持续超过24小时。
超声引导下的QLB2在腹部手术后24小时内使用时，可通过降低疼痛强度和阿片类药物需求量，为全身麻醉下的患者提供有效的镇痛。
