Yimeng Jing, Shishun Zhao, Wenlai Guo, Lu Qin, Yaxin Li, Di You
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引用次数: 0
Abstract
Background: Cesarean section is one of the most common surgical procedures. Currently, there are many analgesic methods available after cesarean section, but the optimal analgesic method after cesarean section is not clear.
Methods: A network meta-analysis of randomized controlled trials was used to search Embase, PubMed, Web of Science, and Cochrane databases. Outcomes included time to first postoperative request for analgesia, postoperative medication-supplemented analgesia, pain scores at four postoperative time points, postoperative complications (nausea and vomiting, itching, and level of sedation), and patient satisfaction.
Result: A total of 110 randomized controlled trials involving 8871 pregnant women were finally included. A total of 17 postoperative analgesic techniques for cesarean delivery were included. Compared with the control group, all modalities except wound infiltration prolonged the time to the first request for analgesia. Transversal abdominal block-type and lumbar quadratus block-type analgesia were effective in decreasing the need for opioids in postoperative patients. Wound infiltration and transverse fascial block decreased the need for nonopioid medications in postoperative patients. The traditional analgesic modalities of intrathecal morphine (IM) and epidural morphine have the best analgesic effect, and the analgesic effect of the type of transversal abdominal block and the type of lumbar square muscle block in local anesthesia is better than that of other local anesthesia modalities. The lateral transversus abdominis block and posterior and anterior lumbar square muscle block can effectively reduce postoperative complications with the best effect. In terms of patient satisfaction, IM with conventional Petit transverse abdominal block was the best.
Conclusions: Regional nerve block is a safe and effective postoperative analgesic modality; QLB III, which is used to use opioids as postoperative supplemental analgesia, is the safest and most effective analgesic modality, and those who are used to use non-opioids as postoperative supplemental analgesia can choose transversus fasciae block as a postoperative analgesic modality.
背景:剖宫产是最常见的外科手术之一。目前剖宫产术后镇痛方法较多,但剖宫产术后最佳镇痛方法尚不明确。方法:采用随机对照试验的网络meta分析,检索Embase、PubMed、Web of Science和Cochrane数据库。结果包括术后首次要求镇痛的时间、术后药物辅助镇痛、术后四个时间点的疼痛评分、术后并发症(恶心呕吐、瘙痒和镇静水平)和患者满意度。结果:最终纳入110项随机对照试验,涉及8871名孕妇。共纳入17种剖宫产术后镇痛技术。与对照组相比,除创面浸润外,所有方式均延长了第一次要求镇痛的时间。横腹阻滞镇痛和腰方肌阻滞镇痛可有效减少术后患者对阿片类药物的需求。伤口浸润和横筋膜阻滞减少了术后患者对非阿片类药物的需求。鞘内吗啡(IM)和硬膜外吗啡的传统镇痛方式镇痛效果最好,且局麻中腹横阻滞型和腰方肌阻滞型的镇痛效果优于其他局麻方式。腹侧横肌阻滞和腰前后方肌阻滞能有效减少术后并发症,效果最好。在患者满意度方面,IM与传统的小腹横阻滞是最好的。结论:局部神经阻滞是一种安全有效的术后镇痛方式;使用阿片类药物作为术后补充镇痛的QLB III是最安全、最有效的镇痛方式,使用非阿片类药物作为术后补充镇痛的患者可选择经筋膜阻滞作为术后镇痛方式。
期刊介绍:
The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.