超声引导下腰方肌阻滞对躯干手术术后疼痛的影响：一项Meta分析-现代医学

超声引导下腰方肌阻滞对躯干手术术后疼痛的影响：一项Meta分析

单位：1. 文昌市人民医院麻醉科, 海南文昌 571300;
2. 南方医科大学珠江医院麻醉科, 广东广州 510280;
3. 湘潭市第一人民医院麻醉手术科, 湖南湘潭 411100

分类号：R614.2

出版年·卷·期（页码）：2023·51·第十二期（1741-1751）

摘要：

目的：应用Meta分析评价超声引导下腰方肌阻滞(QLB)对躯干手术术后疼痛的影响。方法：检索中英文数据库(PubMed、Embase、Web of Science、Cochrane Library、CINAHL、CBM、CNKI、万方、维普)，检索时间从数据库建库至2023年1月。确定文献纳入排除标准，经筛选后纳入符合要求的文献。主要观察指标为术后24 h阿片类药物消耗量，次要观察指标为术后24 h静息状态下视觉模拟评分(VAS)、疼痛数字评分(NRS)以及术后恶心呕吐(PONV)发生率。结果：本研究最终纳入32项随机对照试验，19项研究比较QLB与单纯全身静脉镇痛(对照组进行安慰剂QLB)的效果，4项研究比较QLB和腹横肌平面阻滞(TAPB)的效果，其余研究进行了QLB与其它镇痛方案的比较(如竖脊肌阻滞、髂筋膜阻滞等)。QLB术后24 h阿片类药物消耗量低于安慰剂对照，也低于TAPB对照(P<0.05)。QLB相较于安慰剂对照发生PONV的风险更低。但QLB与安慰剂对照在术后24 h静息状态下VAS和NRS差异均无统计学意义(P>0.05)。结论：在同等静脉镇痛基础上，QLB相较于安慰剂能降低躯干手术术后24 h阿片类药物消耗量，降低PONV的风险；但在静息状态下的VAS和NRS中未能显示出镇痛的优势。与TAPB比较，QLB也能降低躯干手术术后24 h阿片类药物消耗量。

Objective: Meta-analysis was applied to evaluate the effect of ultrasound-guided quadratus lumborum block(QLB) on postoperative pain after trunk surgery. Methods: A search of Chinese and English databases(PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CBM, CNKI, Wanfang, VIP) was performed from database establishment to January 2023. Literatures inclusion and exclusion criteria were determined, and the literatures meeting the requirements after screening. The primary outcome measure was opioids consumption 24 hours after surgery, and the secondary outcome measures were visual analogue scale(VAS), numerical rating scale(NRS), and incidence of postoperative nausea and vomiting(PONV) at rest 24 hours after surgery.Results: Thirty-two randomized controlled trials were finally included in this study, 19 studies compared the effect of QLB with systemic intravenous analgesia alone(QLB with placebo in the control group), 4 studies compared the effect of QLB and transversus abdominis plane block(TAPB), and the remaining studies compared QLB with other analgesic regimens(such as erector spinae block, fascia iliaca block, etc.). Opioids consumption 24 hours after QLB was lower than those of placebo controls and TAPB controls. QLB was associated with a lower risk of PONV compared with placebo controls(P<0.05). However, there were no significant differences in VAS and NRS between QLB and placebo controls at rest 24 hours after surgery(P>0.05). Conclusion: On the basis of equivalent intravenous analgesia, QLB reduced opioids consumption 24 hours after trunk surgery and reduced the risk of PONV compared with placebo; however, it failed to show an advantage in the pain score scales VAS and NRS. Compared with TAPB, QLB also reduced opioids consumption 24 hours after trunk surgery.

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