Meta-analysis: The utility of the anterior quadratus lumborum block in abdominal surgery

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-10-18 DOI:10.1016/j.amjsurg.2024.116014

Brogan G.A. Evans , Jacqueline M.H. Ihnat , K. Lynn Zhao , Leah Kim , Doris Pierson , Catherine T. Yu , Hung-Mo Lin , Jinlei Li , Mehra Golshan , Haripriya S. Ayyala

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引用次数: 0

Abstract

Background

Regional anesthesia is routinely used in Enhanced Recovery After Surgery pathways to improve post-operative recovery times. No consensus has been reached on optimal block type. This study reviews the current literature as it pertains to the anterior quadratus lumborum (aQL) block in all abdominal surgeries, as well as its efficacy compared to the transversus abdominis plane (TAP) block.

Methods

PubMed was searched for original, peer-reviewed articles that include “(anterior) quadratus lumborum block.” 89 articles were included. Data was extracted according to PRISMA guidelines, with articles manually reviewed by two independent reviewers. A meta-analysis was then conducted on a subset of 14 randomized control trials (RCT) evaluating total oral morphine equivalent consumed at 12 and 24 h post-operatively in patients who received an aQL block compared to control.

Results

28 articles were included with 14 RCT used in a random-effects meta-analysis. There was a significant reduction in post-operative pain scores and opioid use in patients who receive an aQL block for abdominal surgeries. Meta-analysis determined a decrease in total oral morphine equivalent consumed at both 12 and 24 h post-operatively compared to controls. Compared to no region block, both the aQL and TAP block show a significant reduction in pain and post-operative opioid consumption.

Conclusion

The literature demonstrates non-inferiority of the aQL block compared to the TAP block in abdominal surgery, with some studies suggesting its superiority. Limitations include heterogeneity in study type and design, as well as the presence of confounding variables when comparing across surgery types.

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元分析：腹部手术中腰前区阻滞的实用性。

背景：区域麻醉是 "术后强化恢复 "路径中的常规方法，可缩短术后恢复时间。目前尚未就最佳阻滞类型达成共识。本研究回顾了与所有腹部手术中前腰四头肌 (aQL) 阻滞相关的现有文献，以及其与腹横肌平面 (TAP) 阻滞相比的疗效：方法：在 PubMed 上搜索包含"（前）腰方肌阻滞 "的原创同行评审文章。共纳入 89 篇文章。根据 PRISMA 指南提取数据，并由两名独立审稿人对文章进行人工审核。然后对14项随机对照试验（RCT）的子集进行了荟萃分析，评估了与对照组相比，接受aQL阻滞的患者在术后12小时和24小时的口服吗啡总当量。接受 aQL 阻滞治疗的腹部手术患者术后疼痛评分和阿片类药物用量明显减少。荟萃分析表明，与对照组相比，术后 12 小时和 24 小时的总口服吗啡当量均有所减少。与无区域阻滞相比，aQL 和 TAP 阻滞都能显著减少疼痛和术后阿片类药物的消耗：文献表明，在腹部手术中，aQL阻滞与TAP阻滞相比并无劣势，一些研究还表明其具有优势。局限性包括研究类型和设计的异质性，以及在比较不同手术类型时存在混杂变量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.