Comparing the analgesic effect of regional nerve block technique in laparoscopic nephrectomy: A systematic review and network meta-analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111829

Hao Liu MS , Longfei Ding MS , Yuewen He MD , Zhengze Zhang MD , Tong Wu MD , Jiacheng Fu MS , Yong Wang MD , Wuhua Ma MD

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引用次数: 0

Abstract

Background

Various regional nerve block techniques have been employed to manage acute pain following laparoscopic nephrectomy; however, the optimal technique remains unclear.

Methods

This network meta-analysis (NMA) compares the analgesic efficacy of various regional nerve block techniques. We conducted a comprehensive search in PubMed, Embase, Web of Science (WOS), Cochrane, and Scopus databases from inception until October 10, 2024, for randomized controlled trials (RCTs) that compare the analgesic efficacy of regional nerve block techniques, including quadratus lumborum block (QLB), transversus abdominis plane block (TAPB), retrolaminar block (RLB), local infiltration anesthesia (LIA), erector spinae block (ESB), paravertebral block (PVB), and epidural analgesia) for post-laparoscopic nephrectomy pain management. The entire NMA analysis was conducted using R software and a Bayesian framework. The primary outcome of this NMA was the cumulative oral morphine equivalent (OME) consumption at 24 h postoperatively. Secondary outcomes included 6-h postoperative OME consumption, intraoperative OME consumption, time to first opioid use, incidence of rescue analgesic use, incidence of nausea and vomiting, and patient satisfaction.

Results

Our direct comparison results indicate that the interventions effectively reduced OME consumption at 24 h and 6 h postoperatively and intraoperatively, extended the time to first opioid use, improved patient satisfaction, and reduced the incidence of postoperative nausea and vomiting. The NMA results demonstrated that preoperative quadratus lumborum block (PreOp QLB; MD -31.23, 95 % CI -54.99 to −9.95; low-quality evidence) and preoperative erector spinae block (PreOp ESB; MD -44.44, 95 % CI -88.03 to −0.97; moderate-quality evidence) significantly reduced the 24-h postoperative OME consumption.

Conclusions

Analysis of existing evidence suggests that PreOp QLB demonstrates a superior advantage over other interventions, significantly reducing 24-h postoperative OME, 6-h postoperative OME, rescue analgesia usage, and the incidence of postoperative nausea and vomiting, as well as extending time to first opioid use. Other interventions, such as PreOp ESB, also show potential benefits. However, due to limitations in the current number of studies and sample sizes, future large-scale, high-quality studies are necessary to further support these findings.

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比较区域神经阻滞技术在腹腔镜肾切除术中的镇痛效果：系统综述和网络荟萃分析

背景：各种区域神经阻滞技术已被用于治疗腹腔镜肾切除术后的急性疼痛；然而，最佳技术仍不清楚。方法采用网络meta分析（NMA）对不同区域神经阻滞方法的镇痛效果进行比较。我们在PubMed， Embase, Web of Science (WOS)， Cochrane和Scopus数据库中进行了全面的检索，从成立到2024年10月10日，检索了比较区域神经阻滞技术镇痛效果的随机对照试验（rct），包括腰方肌阻滞（QLB），腹横面阻滞（TAPB），椎板后阻滞（RLB），局部渗透麻醉（LIA），直立脊柱阻滞（ESB），椎旁阻滞（PVB），以及硬膜外镇痛)用于腹腔镜肾切除术后疼痛管理。整个NMA分析是使用R软件和贝叶斯框架进行的。该NMA的主要终点是术后24小时的累积口服吗啡当量（OME）消耗。次要结局包括术后6小时OME消耗、术中OME消耗、首次阿片类药物使用时间、抢救镇痛药使用发生率、恶心呕吐发生率和患者满意度。结果我们的直接比较结果表明，干预措施有效降低了术后和术中24 h和6 h的OME消耗，延长了首次使用阿片类药物的时间，提高了患者满意度，减少了术后恶心和呕吐的发生率。NMA结果显示术前腰方肌阻滞(PreOp QLB；MD -31.23, 95% CI -54.99 ~ - 9.95；低质量证据)和术前直立脊柱阻滞(PreOp ESB；MD -44.44, 95% CI -88.03 ~ - 0.97；中等质量证据)显著降低了术后24小时OME消耗。结论术前QLB优于其他干预措施，可显著降低术后24小时OME、6小时OME、抢救性镇痛使用、术后恶心呕吐发生率，并延长首次阿片类药物使用时间。其他干预措施，如PreOp ESB，也显示出潜在的好处。然而，由于目前研究数量和样本量的限制，未来需要大规模、高质量的研究来进一步支持这些发现。

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

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.