【罂粟摘要】髂腹股沟-髂下腹阻滞用于剖宫产术的镇痛效果：一项Meta分析和试验序贯分析
剖宫产是临床最常见的手术之一，而其术后镇痛效果会影响到产妇母乳喂养、婴儿的护理等等，从而降低产妇临床满意度。而多模式镇痛的推广使得产妇术后疼痛得到了较好的控制和解决，由于阿片类药物在椎管内麻醉应用不便，作者考虑到以神经阻滞的方法替代，作为术后镇痛的方式。这篇文献分析了髂腹股沟-髂下腹阻滞对剖宫产手术术后镇痛的影响，由于剖宫产手术的手术范围在L1-L2神经支配区，这种阻滞方式也同样为该手术范围的其他手术的术后镇痛模式提供了思路和参考。
髂腹股沟-髂下腹阻滞用于剖宫产术的镇痛效果：一项Meta分析和试验序贯分析
翻译：佟睿 编辑：佟睿 审校：曹莹
剖宫产术后应设计有效的镇痛策略以改善胎儿母体指标。许多最近的研究集中在髂腹股沟-髂下腹(II-IH)阻滞提供这种镇痛的疗效。
随机对照试验的系统综述和meta分析。
本研究旨在于探讨II-IH阻滞在剖宫产手术中的应用效果。主要观察指标是24小时内累积的静脉吗啡当量。分析术后4~6h和24h的疼痛评分、首次解救性止痛的时间和不良反应。
两名审查者独立搜索了PubMed、Embase、谷歌学术和Cochrane中心注册的直至2020年6月的对照试验。
比较II-IH阻滞与单独全身镇痛或安慰剂阻滞(空白对照)的前瞻性随机对照试验符合纳入条件。只纳入对其方法简单明了进行了说明的试验。采用Cochrane方法评估偏倚的风险。数据以95%置信区间(CI)的平均差表示。
本研究共纳入了13项试验，共858名患者。在接受II-IH阻滞的患者中，前24小时阿片类药物(静脉吗啡当量)的用量比安慰剂或不阻滞的患者减少了15.57 mg(95%CI为-19.87~-11.28；P<0.00001；I2=95%)。接受全身麻醉的患者在24小时内对吗啡的需求量比接受椎管内麻醉的患者减少得更多。通过试验序贯分析确定了上述结果的适当“信息量”，以排除假阳性结果的可能性。II-IH也显著降低了静息时的疼痛评分，在4-6小时比24小时更明显。
我们的研究表明，剖宫产患者使用II-IH阻滞与较低的24小时静脉吗啡当量需求有关。然而，考虑到方法学的限制，在有更多的研究可用之前，对数据的解释应该谨慎。
Narinder P. Singh, Jeetinder K. Makkar, Nidhi Bhatia, et al. The analgesic effectiveness of ilioinguinal-iliohypogastric
block for caesarean delivery: A meta-analysis and trial sequential analysis.[J].Eur J Anaesthesiol 2021; 38 (Suppl 2):S87–S96.
The analgesic effectiveness of ilioinguinal-iliohypogastric block for caesarean delivery: A meta-analysis and trial sequential analysis
BACKGROUND An effective analgesia strategy following caesarean delivery should be designed to improve fetomaternal outcomes. Much recent research has focused on the efficacy of ilioinguinal-iliohypogastric (II-IH) block for providing such analgesia.
DESIGN A systematic review and meta-analysis of randomised controlled trials.
OBJECTIVES To investigate the effectiveness of II-IH block in patients undergoing caesarean delivery. The primary outcome was the cumulative parenteral morphine equivalents at 24 h. Pain scores at 4 to 6 and 24 h postsurgery, time to first rescue analgesia and adverse effects were the secondary outcomes analysed.
DATA SOURCES Two reviewers searched independently PubMed, Embase, Google Scholar and the Cochrane central registers of a controlled trial from their inception until June 2020.
METHODOLOGY Prospective randomised control trials comparing II-IH block with either systemic analgesia alone or a placebo block (non-active controls) were eligible for inclusion. Only trials that reported their methods comprehensibly and transparently were included. Cochrane methodology was used to assess the risk of bias. Data are presented as mean difference with 95% confidence interval (CI).
RESULTS Thirteen trials comprising a total of 858 patients were included. Opioid (intravenous morphine equivalents) consumption was reduced by 15.57 mg (95% CI -19.87 to -11.28; P<0.00001; I2=95%) during the first 24h in patients receiving II-IH block when compared with placebo or no block. Patients receiving general anaesthesia showed a greater reduction in morphine requirement at 24 h than those receiving neuraxial anaesthesia. Adequate 'information size’ for the above outcome was confirmed with trial sequential analysis to rule out the possibility of a false-positive result. IIIH also significantly reduced pain scores at rest more so at 4 to 6 h than at 24 h.
CONCLUSIONS Our study suggests that the use of II-IH blocks is associated with a lower 24 h requirement for intravenous morphine equivalents in patients undergoing caesarean delivery. However, given the methodological limitations, data should be interpreted with caution until more studies are available.
Published online 12 November 2020
贵州医科大学高鸿教授课题组