Xiao Dan, Sun Yiyuan, Gong Fang, Yin Yu, Wang Yue
Department of Pediatrics, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China.
Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610017, China.
Medicina (Kaunas). 2023 Aug 24;59(9):1527. doi: 10.3390/medicina59091527.
: Postoperative pain after lower abdominal surgery is typically severe. Traditionally, in pediatric anesthesia, a caudal block (CB) has been used for pain management in these cases. Nowadays, a transversus abdominis plane block (TAPB) seems to be an effective alternative. However, which technique for perioperative analgesia is better and more effective remains unclear in children who undergo abdominal surgeries. The aim of this study was to compare the efficacy and safety of a TAPB and CB for pain management in children after abdominal surgery by conducting a meta-analysis of published papers in this area. : We conducted a thorough search of PubMed, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trials (RCTs) that compared a TAPB and CB for pain management in children who had abdominal surgery. Two researchers screened and assessed all the information with RevMan5.3 used for this meta-analysis. Pain scores, the total dose of rescue analgesic given, the mean duration of analgesia, the intraoperative and postoperative hemodynamic conditions 24 h after surgery, and adverse events were compared. : 15 RCTs that involved a total of 970 pediatric patients were included in this study. The results of this meta-analysis showed that there were no significant differences between the 2 groups in terms of postoperative pain scores at 1 h (SMD = 0.35; 95% CI = -0.54 to 1.24; = 0.44, I = 94%), 6 h (SMD = -0.10; 95% CI = -0.44 to -0.23; = 0.55, I = 69%), 12 h (SMD = -0.02; 95% CI = -0.45 to -0.40; = 0.93, I = 80%), and 24 h (SMD = -0.66; 95% CI = -1.57 to -0.25; = 0.15, I = 94%); additional analgesic requirement (OR 0.25; 95% CI 0.09 to 0.63; = 0.004, I = 72%); total dose of rescue analgesic given in 24 h (SMD = -0.37; 95% CI = -1.33 to -0.58; = 0.44; I = 97%); mean duration of analgesia (SMD = 1.29; 95% CI = 0.01 to 2.57; = 0.05, I = 98%); parents' satisfaction (SMD = 0.44; 95% CI = -0.12 to 1.0; = 0.12; I = 80%); and intraoperative and postoperative hemodynamic conditions 24 h after the surgery and adverse events (SMD = 0.78; 95% CI = 0.22 to 2.82; = 0.70; I = 62%). Compared to a CB, a TAPB resulted in a small but significant reduction in additional analgesic requirement after surgery (OR 0.25; 95% CI 0.09 to 0.63; = 0.004). : TAPBs and CBs result in similar efficient early analgesia and safety profiles in children undergoing abdominal surgeries. Moreover, no disparities were observed for adverse effects between TAPBs and CBs.
下腹部手术后的术后疼痛通常较为严重。传统上,在儿科麻醉中,尾神经阻滞(CB)一直用于此类病例的疼痛管理。如今,腹横肌平面阻滞(TAPB)似乎是一种有效的替代方法。然而,对于接受腹部手术的儿童,哪种围手术期镇痛技术更好、更有效仍不清楚。本研究的目的是通过对该领域已发表论文进行荟萃分析,比较TAPB和CB在儿童腹部手术后疼痛管理中的疗效和安全性。
我们全面检索了PubMed、EMBASE、Cochrane图书馆和科学网,以查找比较TAPB和CB在接受腹部手术儿童中疼痛管理效果的随机对照试验(RCT)。两名研究人员使用RevMan5.3对所有信息进行筛选和评估,用于本荟萃分析。比较了疼痛评分、给予的补救镇痛药总剂量、平均镇痛持续时间、术后24小时的术中及术后血流动力学状况以及不良事件。
本研究纳入了15项RCT,共涉及970例儿科患者。该荟萃分析结果显示,两组在术后1小时(标准化均数差[SMD]=0.35;95%置信区间[CI]=-0.54至1.24;P=0.44,I²=94%)、6小时(SMD=-0.10;95%CI=-0.44至0.23;P=0.55,I²=69%)、12小时(SMD=-0.02;95%CI=-0.45至0.40;P=0.93,I²=80%)和24小时(SMD=-0.66;95%CI=-1.57至-0.25;P=0.15,I²=94%)的术后疼痛评分方面无显著差异;额外镇痛需求(比值比[OR]=0.25;95%CI=0.09至0.63;P=0.004,I²=72%);24小时内给予的补救镇痛药总剂量(SMD=-0.37;95%CI=-1.33至-0.58;P=0.44;I²=97%);平均镇痛持续时间(SMD=1.29;95%CI=0.01至2.57;P=0.05,I²=98%);家长满意度(SMD=0.44;95%CI=-0.12至1.0;P=0.12;I²=80%);以及术后24小时的术中及术后血流动力学状况和不良事件(SMD=0.78;95%CI=0.22至2.82;P=0.70;I²=62%)。与CB相比,TAPB术后额外镇痛需求有小幅但显著的降低(OR=0.25;95%CI=0.09至0.63;P=0.004)。
TAPB和CB在接受腹部手术的儿童中产生相似的有效早期镇痛效果和安全性。此外,未观察到TAPB和CB在不良反应方面存在差异。