切除术后的区域性止痛技术:系统性审查和网络元分析
Jinwen Huang1, Xia Liu2, Lingkai Wang1
1Department of Anesthesiology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Minerva anestesiologica
|November 12, 2024
概括
勃起器脊柱平面阻塞 (ESPB) 和胸部副脊柱阻塞 (TPVB) 有效减少手术后的疼痛和住院时间. 其他技术,如四度腰部阻断 (QLB) 和逆膜阻断 (RLB),对阿片类药物使用和恶心有好处.
科学领域:
- 麻醉学 麻醉学
- 手术疼痛管理手术疼痛管理
- 区域性镇痛 地区性镇痛
背景情况:
- 腎臟手術,包括部分腎切除和腎切除,往往涉及嚴重的術後疼痛.
- 有效的疼痛管理对于患者的康复和减少并发症至关重要.
- 采用了各种区域止痛技术,但它们的比较有效性需要合成.
研究的目的:
- 进行网络元分析 (NMA),比较不同区域止痛技术的疗效和安全性.
- 为了评估疼痛减轻,阿片类药物消费,术后恶心和吐 (PONV),以及住院时间.
- 为脏手术中的止痛策略提供基于证据的建议.
主要方法:
- 从主要数据库 (PubMed,Embase,Web of Science,Cochrane Library) 系统搜索随机对照试验 (RCT),直到2024年1月.
- 使用Stata 15.1软件进行的网络元分析.
- 使用CINeMA方法评估证据的确定性.
主要成果:
- 分析了27项试验,涉及1852名患者和14种技术.
- 勃起器脊柱平面阻断 (ESPB) 和胸部副脊柱阻断 (TPVB) 降低了术后疼痛得分和住院时间.
- 侧面四角腰部块 (QLB-L) 和横筋QLB (QLB-TM) 在减少阿片类药物消费方面表现有前途.
- 复原蛋白块 (RLB) 和前部QLB (QLB-LSAL) 与PONV降低有关.
结论:
- 建议ESPB和TPVB用于减少脏手术后的疼痛和住院时间.
- QLB-L和QLB-TM对于最大限度地减少阿片类药物需求是有效的.
- RLB和QLB-LSAL可以帮助减少PONV发病率.
- 伤口透 (WI) 和腹腔内插入 (IPI) 等技术似乎不那么有效.
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