摘要
目的 采用系统评价和Meta分析的方法评估前路腰方肌阻滞(QLB)在全髋关节置换术(THA)后多模式镇痛中的作用。方法 计算机检索PubMed、Embase、the Cochrane Library、中国知网、万方等中英文数据库,从建库至2022-01-31以中英文发表的、比较前路QLB和对照组(未进行神经阻滞)用于THA术后镇痛的随机对照试验(RCT)研究,按照Cochrane手册选择文献、提取资料、对纳入文献的方法学质量进行评价,采用RevMan 5.4进行Meta分析。结果 最终纳入11篇RCT,共777例患者。与未行神经阻滞相比,前路QLB可降低THA患者术后12 h(MD=-1.33,95%CI为-1.71~-0.95,P<0.001)、24 h(MD=-1.33,95%CI为-1.74~-0.92,P<0.001)、48 h(MD=-1.10,95%CI为-1.59~-0.62,P<0.001)的静息痛评分和术后24 h(MD=-3.03,95%CI为-3.53~-2.53,P<0.001)、48 h(MD=-2.24,95%CI为-2.67~-1.82,P<0.001)的活动痛评分,减少术后24 h(MD=-12.99,95%CI为-21.17~-4.82,P=0.002)和48 h(MD=-22.82,95%CI为-30.69~-14.94,P<0.001)的等效静脉吗啡消耗量。同时降低术后恶心呕吐(PONV)的发生率,增加术后24、36和48 h髋关节最大屈曲和外展活动度,提高患者满意度,均P<0.001;并且不增加其他不良反应发生率,不延长住院时间。结论 术后多模式镇痛中增加前路QLB可有效控制THA术后疼痛,减少阿片类药物消耗,降低POVN发生率,提高患者满意度,但不能确定这些优势是否有助于患者术后运动功能的早期恢复。
Objective To evaluate the role of anterior quadratus lumborum block(QLB) on postoperative multi-mode analgesia after total hip arthroplasty(THA) by systematic review and Meta-analysis.Methods The Chinese and English databases of PubMed, Embase, the Cochrane Library, CNKI, Wanfang, etc. were searched by computer, and the randomized controlled trial(RCT) study published in Chinese and English from the establishment of the database to January 31, 2022, comparing the anterior QLB and the control group(without nerve block) for postoperative analgesia after THA was searched, the language limited to Chinese and English. Literature selection, data extraction and methodological quality evaluation were according to the Cochrane handbook. The Meta-analysis was performed by RevMan 5.4 software. Results Eleven RCTs with a total of 777 patients were included. Compared with patients without nerve block, anterior QLB significantly reduced the pain score at rest at 12 h(MD=-1.33, 95%CI:-1.71 to-0.95, P<0.001), 24 h(MD=-1.33, 95%CI:-1.74 to-0.92, P<0.001), 48 h(MD=-1.10, 95%CI:-1.59 to-0.62, P<0.001) after surgery, and reduced the pain score during activity at 24 h(MD=-3.03, 95%CI:-3.53 to-2.53, P<0.001), 48 h(MD=-2.24, 95%CI:-2.67 to-1.82, P<0.001) after surgery, decreased the equivalent morphine consumption at 24 h(MD=-12.99, 95%CI:-21.17 to-4.82, P<0.001), 48 h(MD=-22.82, 95%CI:-30.69 to -14.94,P<0.001)after surgery.At the same time,the incidence of postoperative nausea and vomiting(PONV)was reduced,the maximum flexion and abduction range of motion of the hip joint were increased at 24,36and 48hours after operation,and the patient satisfaction was improved,all P<0.001.Besides,it did not increase the incidence of other adverse reactions and does not extend the length of hospital stay.Conclusions The addition of anterior QLB in postoperative multimodal analgesia can effectively control postoperative pain after THA,decrease opioid consumption,reduce the incidence of POVN,and improve patient satisfaction,but it is uncertain whether
作者
陈剑明
郝志敏
朱彩艳
CHEN Jianming;HAO Zhimin;ZHU Caiyan(Depatment of Anesthesiology,Shenzhen Second People's Hospital,Shenzhen 518035,China;Depatment of Anesthesiology,Southern University of Science and Technology Hospital,Shenzhen 518055,China)
出处
《社区医学杂志》
CAS
2023年第8期424-430,共7页
Journal Of Community Medicine
关键词
前路腰方肌阻滞
全髋关节置换术
静息痛
活动痛
等效静脉吗啡消耗
META分析
anterior quadratus lumborum block
total hip arthroplasty
resting pain
activity pain
equivalent morphine consumption
Meta-analysis
