Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China.
Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China.
J Perianesth Nurs. 2023 Jun;38(3):493-503. doi: 10.1016/j.jopan.2022.09.003. Epub 2023 Jan 27.
This review aimed to conduct a meta-analysis of published randomized controlled studies (RCTs) comparing the effectiveness of dexmedetomidine (DEX) combined with ropivacaine versus single ropivacaine in transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic cholecystectomy (LC). The purpose was to investigate whether DEX combined with ropivacaine in TAPB for postoperative analgesia in LC is superior to single ropivacaine administration.
A Systematic Review and Meta-analysis.
Five electronic database systems were searched for RCTs on the effects of DEX combined with ropivacaine (joint group) and single ropivacaine on postoperative analgesia in LC. The standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence interval (CI) of the indicators were calculated for comparison.
As of December 23, 2021, 153 articles were retrieved, but only 16 articles were finally included in this meta-analysis. The results showed that compared with single ropivacaine, DEX combined with ropivacaine in TAPB had better analgesia and lighter sedative effect in patients after LC. After LC 2h(T1), 4h(T2), 8h(T3), 12h(T4) and 24h (T5), the joint group participants have lower VAS scores (T1: SMD = -0.32, 95%CI: -0.49, -0.14; T2: SMD = -1.11, 95%CI: -1.56, -0.65; T3: SMD = -2.88, 95%CI: -3.74, -2.02; T4: SMD = -2.56, 95%CI: -3.04, -2.08; T5: SMD = -1.44, 95%CI: -1.81, -1.06). Also, the Ramsay score of the joint group is higher than the single group (T1: SMD = 1.05, 95%CI: 0.39, 1.71; T2: SMD = 1.57, 95%CI: 0.57, 2.57; T3: SMD = 1.64, 95%CI: 0.65, 2.63; T4: SMD = 1.72, 95%CI: 0.54, 2.89; T5: SMD = 0.57, 95%CI: 0.21, 0.94).
The results of this review and meta-analysis suggest that DEX combined with ropivacaine has less postoperative pain, more patients got the status of sober and cooperative, and longer postoperative analgesia lasted than ropivacaine alone in TAPB, especially in the group of combined treatment with 1.0 mcg/kg DEX. Furthermore, the flow dynamics of the two groups are stable, and there is no notable difference in the incidence of adverse reactions.
本研究旨在通过荟萃分析已发表的随机对照试验（RCTs），比较右美托咪定（DEX）联合罗哌卡因与单纯罗哌卡因在腹腔镜胆囊切除术（LC）后经腹横肌平面阻滞（TAPB）中的有效性，以评估 DEX 联合罗哌卡因在 LC 术后镇痛中的优越性。
系统评价和荟萃分析。
检索了五个电子数据库系统中关于 DEX 联合罗哌卡因（联合组）和单纯罗哌卡因对 LC 术后镇痛影响的 RCTs。计算了指标的标准化均数差（SMD）或比值比（OR）及其相应的 95%置信区间（CI）进行比较。
截至 2021 年 12 月 23 日，共检索到 153 篇文章，但最终只有 16 篇文章纳入本荟萃分析。结果表明，与单纯罗哌卡因相比，DEX 联合罗哌卡因在 TAPB 中对 LC 患者具有更好的镇痛效果和较轻的镇静作用。在 LC 后 2 小时（T1）、4 小时（T2）、8 小时（T3）、12 小时（T4）和 24 小时（T5），联合组患者的 VAS 评分较低（T1：SMD=-0.32，95%CI：-0.49，-0.14；T2：SMD=-1.11，95%CI：-1.56，-0.65；T3：SMD=-2.88，95%CI：-3.74，-2.02；T4：SMD=-2.56，95%CI：-3.04，-2.08；T5：SMD=-1.44，95%CI：-1.81，-1.06）。此外，联合组的 Ramsay 评分高于单纯组（T1：SMD=1.05，95%CI：0.39，1.71；T2：SMD=1.57，95%CI：0.57，2.57；T3：SMD=1.64，95%CI：0.65，2.63；T4：SMD=1.72，95%CI：0.54，2.89；T5：SMD=0.57，95%CI：0.21，0.94）。
本综述和荟萃分析的结果表明，DEX 联合罗哌卡因用于 TAPB 时，与单纯罗哌卡因相比，术后疼痛减轻，清醒合作状态的患者更多，术后镇痛持续时间更长，特别是在联合使用 1.0mcg/kg DEX 时。此外，两组患者的血流动力学稳定，不良反应发生率无显著差异。
