Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Center of Evidence Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan.
Center of Evidence Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of General Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Pain Physician. 2022 Nov;25(8):543-553.
Single-injection regional analgesia techniques can provide effective analgesia for abdominal hysterectomy. However, few randomized controlled trials (RCTs) have directly compared these techniques for total abdominal hysterectomy (TAH), and the best strategy remains unknown.
In this network meta-analysis, we compared the analgesic efficacy of single-injection regional analgesia techniques in patients who underwent TAH.
A systematic review and network meta-analysis.
We searched the PubMed, Embase, Cochrane, and CINAHL databases for relevant trials from inception until April 2022. RCTs that examined single-injection regional analgesia techniques for TAH were included. Random-effects network meta-analyses were performed using the frequentist approach. The primary outcome was 24-hour cumulative morphine equivalent consumption. The secondary outcomes were pain scores, time to first request for rescue analgesia, and rates of postoperative nausea and vomiting (PONV).
In total, 36 RCTs were included. Network meta-analyses indicated that the erector spinae plane block provided superior analgesia in terms of reduced morphine consumption, low PONV incidence, and longer time to first analgesia request. Moreover, compared with control (i.e., sham or placebo), the quadratus lumborum block provided superior analgesia in terms of time to first analgesia request and resting pain scores.
(1) Few studies have examined single-injection regional analgesia techniques other than the transversus abdominis plane block (TAPB) and wound infiltration, leading to a few indirect effect estimates. (2) Heterogeneity existed due to analgesic type/dose, plane block timing, and injection site. (3) Objective outcomes, such as length of hospital stay, were lacking; most studies only included the patient-reported subjective pain score.
Single-injection blocks are effective analgesic techniques for TAH. Among them, the erector spinae plane block and quadratus lumborum block seem to have superior effects. Further studies should evaluate techniques other than TAPB and wound infiltration to draw definitive conclusions.
单次注射区域阻滞技术可为腹式子宫切除术提供有效的镇痛效果。然而，很少有随机对照试验（RCT）直接比较这些技术在全子宫切除术（TAH）中的效果，因此最佳策略仍不清楚。
在本网络荟萃分析中，我们比较了 TAH 患者中单次注射区域阻滞技术的镇痛效果。
系统评价和网络荟萃分析。
我们检索了 PubMed、Embase、Cochrane 和 CINAHL 数据库，以获取自成立以来至 2022 年 4 月的相关试验。纳入研究 TAH 中单次注射区域阻滞技术的 RCT。使用似然法进行随机效应网络荟萃分析。主要结局为 24 小时累积吗啡等效消耗量。次要结局为疼痛评分、首次请求解救性镇痛的时间以及术后恶心呕吐（PONV）发生率。
共纳入 36 项 RCT。网络荟萃分析表明，竖脊肌平面阻滞在减少吗啡消耗量、降低 PONV 发生率和延长首次镇痛请求时间方面提供了更好的镇痛效果。此外，与对照组（即假对照或安慰剂）相比，腰方肌阻滞在首次镇痛请求时间和静息疼痛评分方面提供了更好的镇痛效果。
（1）除了腹横肌平面阻滞（TAPB）和切口浸润以外，很少有研究检查了其他单次注射区域阻滞技术，导致了一些间接效应估计。（2）由于镇痛类型/剂量、平面阻滞时机和注射部位的不同，存在异质性。（3）缺乏客观结局，如住院时间；大多数研究仅包括患者报告的主观疼痛评分。
单次注射阻滞技术是 TAH 的有效镇痛技术。其中，竖脊肌平面阻滞和腰方肌阻滞似乎效果更好。应进一步评估 TAPB 和切口浸润以外的技术，以得出明确的结论。
