Jeffries Sean D, Harutyunyan Robert, Morse Joshua, Hemmerling Thomas M
Department of Experimental Surgery, McGill University Health Center, Montréal, Canada.
Department of Anaesthesia, McGill University, Montréal, Canada.
Indian J Anaesth. 2024 Feb;68(2):142-152. doi: 10.4103/ija.ija_1099_23. Epub 2024 Jan 29.
Rectus sheath block (RSB) is an effective postoperative pain control technique in abdominal surgical procedures. This systematic review evaluated the efficacy and outcome data of patients undergoing RSB compared to the standard of care in both laparoscopic and open surgical procedures.
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42022372596). The search was restricted to randomised controlled trials (RCTs) comparing RSB effectiveness on postoperative pain to any standard general anaesthesia technique (control). We systematically explored PubMed, Medline, Central, Scopus and Web of Science for RCTs from inception to September 2023. The primary outcome was the evaluation of pain scores at rest 0-2, 10-12 and 12-24 h postoperatively. The secondary outcome was the analysis of postoperative intravenous (IV) morphine equivalent consumption at 24-h. A risk-of-bias tool for randomised trials (ROB 2.0, Cochrane, Copenhagen, Denmark) assessment and Grades of Recommendation, Assessment, Development and Evaluation (GRADE, Cochrane, Copenhagen, Denmark) analysis was conducted to evaluate the quality of the RCTs.
Twenty RCTs involving 708 participants who received RSB intervention and 713 who received alternative analgesic care were included. RSB pain scores were significantly lower than control at 0-2 h ( < 0.001) and 10-12 h ( < 0.001) postoperatively. No significant effect was observed at 24 h ( = 0.11). RSB performance compared to control in 24-h IV morphine equivalency in milligrams was significantly lower ( < 0.001).
RSB implementation was associated with reduced postoperative pain scores and decreased opioid consumption in IV morphine equivalency up to 24 h following surgical intervention.
腹直肌鞘阻滞（RSB）是腹部外科手术中一种有效的术后疼痛控制技术。本系统评价比较了接受RSB治疗的患者与腹腔镜和开放手术中标准治疗方法相比的疗效和结局数据。
本系统评价遵循系统评价和Meta分析的首选报告项目指南（PROSPERO注册号：CRD42022372596）。检索仅限于将RSB对术后疼痛的有效性与任何标准全身麻醉技术（对照）进行比较的随机对照试验（RCT）。我们系统地检索了PubMed、Medline、CENTRAL、Scopus和Web of Science，以查找从创刊到2023年9月的RCT。主要结局是评估术后0 - 2小时、10 - 12小时和12 - 24小时的静息疼痛评分。次要结局是分析术后24小时静脉注射（IV）吗啡当量的消耗量。使用随机试验偏倚风险工具（ROB 2.0，Cochrane，丹麦哥本哈根）进行评估，并进行推荐分级、评估、制定和评价（GRADE，Cochrane，丹麦哥本哈根）分析，以评估RCT的质量。
纳入了20项RCT，其中708名参与者接受了RSB干预，713名接受了替代镇痛护理。术后0 - 2小时（<0.001）和10 - 12小时（<0.001），RSB组的疼痛评分显著低于对照组。术后24小时未观察到显著效果（P = 0.11）。与对照组相比，RSB组术后24小时静脉注射吗啡当量（毫克）显著更低（<0.001）。
在手术干预后长达24小时内，实施RSB与降低术后疼痛评分和减少静脉注射吗啡当量的阿片类药物消耗量相关。
