剖宫产术后腹横肌平面阻滞与切口浸润镇痛效果及安全性的Meta分析
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摘要
目的通过Meta分析的方法评价剖宫产术后腹横肌平面阻滞和切口浸润镇痛效果及安全性。方法依据检索策略对Embase、The Cochrane Library、Web of Science、PubMed、维普数据库、中国知网、万方数据库、中国生物医学文献数据库及中国科学引文数据库进行检索,按照纳入及排除标准,筛选对比腹横肌平面阻滞和切口浸润对剖宫产术后镇痛效果的随机对照试验,利用Review Manager 5.3软件对纳入的文献进行Meta分析。结果共检索到1 106篇文献,筛选后最终纳入8篇文献,共532例患者。Mata分析结果显示:腹横肌平面阻滞组剖宫产术后6 h内镇痛效果优于切口浸润组(SMD=-0.35,95%CI:[-0.49,-0.20],P <0.05),腹横肌平面阻滞组首次使用镇痛药的时间较切口浸润组更晚(SMD=1.57,95%CI:[0.55,2.60], P <0.05),而切口浸润组在剖宫产术后48 h吗啡使用量更少(MD=4.60,95%CI:[4.26,4.94], P <0.05)。术后12、24、48 h二者镇痛效果及不良反应方面差异无统计学意义。结论剖宫产术后6 h内,腹横肌平面阻滞的镇痛效果优于切口浸润,且持续时间更长,但切口浸润吗啡用量更少。
Objective To compare the analgesic effects and safety of transversus abdominis plane block and wound infiltration after caesarean section through a Meta-analysis. Methods According to the search strategy,we searched the databases of Embase, The Cochrane Library, Web of Science, PubMed, Weipu Datebase,China Knowledge Network Infrastructure, Wanfang Datebase, China Biology Medicine Disc and Chinese Science Citation Database. Randomized controlled trials comparing the analgesic effects of transversus abdominis plane block and wound infiltration on Cesarean section were screened according to the standard of the row. Review manager 5.3 software was used for quality evaluation and the meta-analysis. Results We searched 1 106 trials and settled on 8 trials containing 532 patients meeting our inclusion criteria. The results of the meta analysis showed that the early analgesiac effect of transversus abdominis plane block anesthesia after Cesarean section was better than that of wound infiltration(SMD =-0.35, 95% CI: [-0.49,-0.20], P <0.05). During the time of the first use of anesthesia after surgery, compared with wound infiltration, the transversus abdominis plane b lock was longer(SMD = 1.57, 95% CI: [0.55, 2.60], P < 0.05), while the dosage of morphine was less used 48 hours after surgery(MD = 4.60, 95% CI: [4.26, 4.94], P < 0.05). There were no significant differences in adverse reactions and analgesic effects between the 12, 24 and 48 h postoperative hours. Conclusion Within 6 h after Cesarean section, the transversus abdominis plane block was better than the wound infiltration for analgesia, the duration was longer, but the amount of morphine was less in the incision infiltration group.
Objective To compare the analgesic effects and safety of transversus abdominis plane block and wound infiltration after caesarean section through a Meta-analysis. Methods According to the search strategy,we searched the databases of Embase, The Cochrane Library, Web of Science, PubMed, Weipu Datebase,China Knowledge Network Infrastructure, Wanfang Datebase, China Biology Medicine Disc and Chinese Science Citation Database. Randomized controlled trials comparing the analgesic effects of transversus abdominis plane block and wound infiltration on Cesarean section were screened according to the standard of the row. Review manager 5.3 software was used for quality evaluation and the meta-analysis. Results We searched 1 106 trials and settled on 8 trials containing 532 patients meeting our inclusion criteria. The results of the meta analysis showed that the early analgesiac effect of transversus abdominis plane block anesthesia after Cesarean section was better than that of wound infiltration(SMD =-0.35, 95% CI: [-0.49,-0.20], P <0.05). During the time of the first use of anesthesia after surgery, compared with wound infiltration, the transversus abdominis plane b lock was longer(SMD = 1.57, 95% CI: [0.55, 2.60], P < 0.05), while the dosage of morphine was less used 48 hours after surgery(MD = 4.60, 95% CI: [4.26, 4.94], P < 0.05). There were no significant differences in adverse reactions and analgesic effects between the 12, 24 and 48 h postoperative hours. Conclusion Within 6 h after Cesarean section, the transversus abdominis plane block was better than the wound infiltration for analgesia, the duration was longer, but the amount of morphine was less in the incision infiltration group.
引文
[1]刘菊芬,刘建蒙,李宏田.2008-2014中国剖宫产率变化趋势和地区差异研究[J].中华预防医学杂志,2017,51(3):242
[2]Patel R,Carvalho JCA,Downey K,et al.Intraperitoneal instillation of lidocaine improves postoperative analgesia at cesarean delivery[J].Anesthesia&Analgesia,2017,124(2):554-559
[3]Sutton CD,Carvalho B.Optimal pain management after cesarean delivery[J].Anesthesiology Clinics,2017,35(1):107-124
[4]Colleen SM,Doyle LT,Maryann C,et al.Effects of connective tissue massage on pain in primiparous women after cesarean birth[J].Journal of Obstetric,Gynecologic&Neonatal Nursing,2018,47(5):591-601
[5]Schmidt P,Berger MB,Day L,et al.Home opioid use followound infiltrationng cesarean delivery:how many opioid tablets should obstetricians prescribe?[J].Journal of Obstetrics&Gynaecology Research,2018,44(4):723-729
[6]Tawfik MM,Mohamed YM,Elbadrawi RE,et al.Transversus abdominis plane block versus wound infiltration for analgesia after cesarean delivery:a randomized controlled trial[J].Anesthesia&Analgesia,2017,124(4):1291-1297
[7]Andrianimaro FM,Rasamoelina N,Rakotomahenina H,et al.Parietal infiltration wound infiltrationth bupivacaine on pain management post cesarean section[J].ParipexIndian Journal of Research,2018,7(2):555-557
[8]Hopp L.Risk of bias reporting in cochrane systematic reviews[J].International Journal of Nursing Practice,2015,21(5):683-686
[9]Aydogmus M,Sinikoglu S,Naki M,et al.Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia[J].Hippokratia,2014,18(1):28-31
[10]Chandon M,Agnès B,Burg Y,et al.Ultrasound-guided transversus abdominis plane block versus continuous wound infusion for post-caesarean analgesia:a randomized trial[J].PLoS One,2014,9(8):e103971
[11]Telnes A,Skogvoll E,Lonnée H.Transversus abdominis plane block vs.wound infiltration in Caesarean section:a randomised controlled trial[J].Acta Anaesthesiologica Scandinavica,2015,59(4):496-504
[12]G?rkemü,Ko?yi?it K,To?rul C,et al.Comparison of bilateral transversus abdominis plane block and wound infiltration wound infiltrationth bupivacaine for postoperative analgesia after cesarean delivery[J].Journal of the Turkish-German Gynecological Association,2017,18(1):26-32
[13]Klasen F,Bourgoin A,Antonini F,et al.Postoperative analgesia after caesarean section wound infiltrationth transversus abdominis plane block or continuous infiltration wound catheter:a randomized clinical trial[J].Anaesthesia Critical Care&Pain Medicine,2016,35(6):401-406
[14]Ahmad M,Furqan A,Adnan M,et al.Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients[J].Anaesthesia,Pain and Intensive Care,2017,21(3):312-316
[15]占大兴,邹高锐,陈超,等.局部浸润镇痛和腹横肌平面阻滞用于剖宫产术后镇痛的效果比较[J].中国医药导报,2017,14(34):58-61
[16]Jadon A,Jain P,Chakraborty S,et al.Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section:a randomized double blind clinical study[J].BMC Anesthesiology,2018,18(1):53-59
[17]Champaneria R,Shah L,Wilson MJ,et al.Clinical effectiveness of transversus abdominis plane(TAP)bocks for pain relief after caesarean section:a Meta-analysis[J].International Journal of Obstetric Anesthesia,2016,61(2):45-60
[18]Guo Qing-duo,Li Rui,Wang Li-xian,et al.Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia:a systematic review and Meta-analysis[J].International Journal of Clinical and Experimental Medicine,2015,8(10):17343-17352
[19]Khalaf WM,Ibrahim MEM,Safwat S.Subrectal and subcutaneous wound infiltration wound infiltrationth bupivacaine versus pethidine for post cesarean section pain relief:randomized controlled trial[J].Open Journal of Obstetrics and Gynecology,2018,8(11):1071-1083
[20]Kundra S,Singh RM,Singh G,et al.Efficacy of magnesium sulphate as an adjunct to ropivacaine in local infiltration for postoperative pain followound infiltrationng lower segment caesarean section[J].Journal of Clinical and Diagnostic Research,2016,10(4):UC18-UC22
[21]Adesope O,Ituk U,Habib AS.Local anaesthetic wound infiltration for postcaesarean section analgesia[J].European Journal of Anaesthesiology,2016,33(10):731-742
[2]Patel R,Carvalho JCA,Downey K,et al.Intraperitoneal instillation of lidocaine improves postoperative analgesia at cesarean delivery[J].Anesthesia&Analgesia,2017,124(2):554-559
[3]Sutton CD,Carvalho B.Optimal pain management after cesarean delivery[J].Anesthesiology Clinics,2017,35(1):107-124
[4]Colleen SM,Doyle LT,Maryann C,et al.Effects of connective tissue massage on pain in primiparous women after cesarean birth[J].Journal of Obstetric,Gynecologic&Neonatal Nursing,2018,47(5):591-601
[5]Schmidt P,Berger MB,Day L,et al.Home opioid use followound infiltrationng cesarean delivery:how many opioid tablets should obstetricians prescribe?[J].Journal of Obstetrics&Gynaecology Research,2018,44(4):723-729
[6]Tawfik MM,Mohamed YM,Elbadrawi RE,et al.Transversus abdominis plane block versus wound infiltration for analgesia after cesarean delivery:a randomized controlled trial[J].Anesthesia&Analgesia,2017,124(4):1291-1297
[7]Andrianimaro FM,Rasamoelina N,Rakotomahenina H,et al.Parietal infiltration wound infiltrationth bupivacaine on pain management post cesarean section[J].ParipexIndian Journal of Research,2018,7(2):555-557
[8]Hopp L.Risk of bias reporting in cochrane systematic reviews[J].International Journal of Nursing Practice,2015,21(5):683-686
[9]Aydogmus M,Sinikoglu S,Naki M,et al.Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia[J].Hippokratia,2014,18(1):28-31
[10]Chandon M,Agnès B,Burg Y,et al.Ultrasound-guided transversus abdominis plane block versus continuous wound infusion for post-caesarean analgesia:a randomized trial[J].PLoS One,2014,9(8):e103971
[11]Telnes A,Skogvoll E,Lonnée H.Transversus abdominis plane block vs.wound infiltration in Caesarean section:a randomised controlled trial[J].Acta Anaesthesiologica Scandinavica,2015,59(4):496-504
[12]G?rkemü,Ko?yi?it K,To?rul C,et al.Comparison of bilateral transversus abdominis plane block and wound infiltration wound infiltrationth bupivacaine for postoperative analgesia after cesarean delivery[J].Journal of the Turkish-German Gynecological Association,2017,18(1):26-32
[13]Klasen F,Bourgoin A,Antonini F,et al.Postoperative analgesia after caesarean section wound infiltrationth transversus abdominis plane block or continuous infiltration wound catheter:a randomized clinical trial[J].Anaesthesia Critical Care&Pain Medicine,2016,35(6):401-406
[14]Ahmad M,Furqan A,Adnan M,et al.Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients[J].Anaesthesia,Pain and Intensive Care,2017,21(3):312-316
[15]占大兴,邹高锐,陈超,等.局部浸润镇痛和腹横肌平面阻滞用于剖宫产术后镇痛的效果比较[J].中国医药导报,2017,14(34):58-61
[16]Jadon A,Jain P,Chakraborty S,et al.Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section:a randomized double blind clinical study[J].BMC Anesthesiology,2018,18(1):53-59
[17]Champaneria R,Shah L,Wilson MJ,et al.Clinical effectiveness of transversus abdominis plane(TAP)bocks for pain relief after caesarean section:a Meta-analysis[J].International Journal of Obstetric Anesthesia,2016,61(2):45-60
[18]Guo Qing-duo,Li Rui,Wang Li-xian,et al.Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia:a systematic review and Meta-analysis[J].International Journal of Clinical and Experimental Medicine,2015,8(10):17343-17352
[19]Khalaf WM,Ibrahim MEM,Safwat S.Subrectal and subcutaneous wound infiltration wound infiltrationth bupivacaine versus pethidine for post cesarean section pain relief:randomized controlled trial[J].Open Journal of Obstetrics and Gynecology,2018,8(11):1071-1083
[20]Kundra S,Singh RM,Singh G,et al.Efficacy of magnesium sulphate as an adjunct to ropivacaine in local infiltration for postoperative pain followound infiltrationng lower segment caesarean section[J].Journal of Clinical and Diagnostic Research,2016,10(4):UC18-UC22
[21]Adesope O,Ituk U,Habib AS.Local anaesthetic wound infiltration for postcaesarean section analgesia[J].European Journal of Anaesthesiology,2016,33(10):731-742