Quadratus Lumborum Block for Total Laparoscopic Hysterectomy: A Systematic Review and Meta-analysis.

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Jin Wu, Yuanfang Ou, Yi Gu, Xiaofeng Zhou, Huiyu She, Yifan Qin
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引用次数: 0

Abstract

Objective: No regional blockade techniques are considered standard of care for total laparoscopic hysterectomy (TLH). Quadratus lumborum block (QLB), a novel fascial plane block, has emerged as a potential option; however, its analgesic efficacy in TLH remains unclear.

Data sources: We conducted a comprehensive search across multiple databases, including Medline PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science. No filters or language restrictions were imposed.

Methods of study selection: The Population, Intervention, Comparison, and Outcomes framework in this review was as follows: (1) adult patients undergoing TLH; (2) QLB as the intervention; (3) comparison with no block or placebo; (4) primary outcome: 24-hour postoperative intravenous morphine-equivalent consumption; secondary outcomes: postoperative pain at 2, 4, 6, 12, and 24 hours, and the incidence of postoperative nausea and vomiting (PONV); (5) randomized controlled trials. Meta-analyses, including subgroup and sensitivity analyses, were conducted using a random-effects model.

Tabulation, integration, and results: This analysis included 8 trials with 540 patients. QLB significantly reduced postoperative 24-hour intravenous morphine-equivalent consumption following TLH (mean difference: -4.61 mg; 95% confidence interval: -7.13 to -2.09; p <.001; I² = 57%), though the reduction was below the minimal clinically important difference (MCID) of 10 mg. The static pain scores at 2, 6, and 12 hours, as well as dynamic pain scores at 2, 6, and 24 hours postoperatively, were significantly lower in the QLB group than in the control group. However, only the 2-hour postoperative dynamic pain score (mean difference = 1.19) exceeded the MCID of 1. No statistically significant differences were observed in the incidence of PONV.

Conclusion: QLB statistically reduced postoperative opioid consumption and pain scores at certain time points after TLH, but only the 2-hour dynamic pain score exceeded the MCID with no improvement in PONV, suggesting limited clinical benefit of QLB in TLH.

腰方肌阻滞用于腹腔镜全子宫切除术:一项系统综述和荟萃分析。
目的:无区域封锁技术被认为是腹腔镜全子宫切除术(TLH)的标准护理。腰方肌阻滞(QLB)是一种新的筋膜平面阻滞,已成为潜在的选择;然而,其在TLH中的镇痛作用尚不清楚。数据来源:我们在多个数据库中进行了全面的搜索,包括Medline PubMed、Embase、Cochrane Central Register of Controlled Trials和Web of Science。没有过滤器或语言限制。研究选择方法:本综述的人群、干预、比较和结局框架如下:(1)接受TLH的成年患者;(2) QLB作为干预;(3)与无阻断剂或安慰剂的比较;(4)主要结局:术后24小时静脉吗啡当量用量;次要结局:术后2、4、6、12和24小时疼痛,以及术后恶心和呕吐(PONV)的发生率;(5)相关。采用随机效应模型进行meta分析,包括亚组分析和敏感性分析。制表、整合和结果:本分析包括8项试验,540例患者。QLB显著降低TLH术后24小时静脉吗啡当量用量[平均差值(MD): -4.61 mg;95% CI: -7.13 ~ -2.09;P < 0.001;I² = 57%],但减少量低于最小临床重要差异(MCID) 10 mg。QLB组术后2、6、12小时的静态疼痛评分,以及术后2、6、24小时的动态疼痛评分,均显著低于对照组。然而,只有术后2小时动态疼痛评分(MD = 1.19)超过MCID 1。PONV的发生率无统计学差异。结论:QLB可显著降低TLH术后某些时间点阿片类药物消耗和疼痛评分,但仅2小时动态疼痛评分超过MCID, PONV无改善,提示QLB在TLH中的临床获益有限。
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
CiteScore
5.00
自引率
7.30%
发文量
272
审稿时长
37 days
期刊介绍: The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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