Abstract：
OBJECTIVE: To determine which locoregional techniques are effective in managing post-operative pain in major open oncologic gynecologic surgery in terms of pain scores and opioid consumption when epidural analgesia is not a feasible option.
METHODS: A systematic review of the literature, based on the Preferred Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, was conducted. The ROB-2 assessment was used to assess bias. The primary outcomes were opioid consumption and post-operative pain scores. Secondary outcomes included post-operative markers such as time to mobilization and bowel movement.
RESULTS: A total of nine studies (n=714) were included in the analysis. Eight studies had a low risk of bias. Five different forms of locoregional analgesia were described. Eight studies compared with placebo and one study compared rectus sheath block with epidural analgesia. Three of the five studies investigating transversus abdominis plane (TAP) blocks showed an improvement in pain scores and opioid consumption when compared with the placebo group. One study investigating rectus sheath blocks and another investigating paravertebral blocks demonstrated significantly less opioid consumption and improved pain scores at certain time points. The studies investigating continuous wound infiltration and superior hypogastric plexus block found no significant effect. No adverse effects of locoregional anesthesia were found.
CONCLUSIONS: Our study showed that TAP blocks, rectus sheath blocks, and paravertebral blocks may decrease opioid consumption and improve pain scores in patients undergoing open abdominal surgery for gynecologic cancer. Additionally, these techniques might serve as a viable alternative for patients with contraindications to epidural analgesia.
METHODS: A systematic review of the literature, based on the Preferred Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, was conducted. The ROB-2 assessment was used to assess bias. The primary outcomes were opioid consumption and post-operative pain scores. Secondary outcomes included post-operative markers such as time to mobilization and bowel movement.
RESULTS: A total of nine studies (n=714) were included in the analysis. Eight studies had a low risk of bias. Five different forms of locoregional analgesia were described. Eight studies compared with placebo and one study compared rectus sheath block with epidural analgesia. Three of the five studies investigating transversus abdominis plane (TAP) blocks showed an improvement in pain scores and opioid consumption when compared with the placebo group. One study investigating rectus sheath blocks and another investigating paravertebral blocks demonstrated significantly less opioid consumption and improved pain scores at certain time points. The studies investigating continuous wound infiltration and superior hypogastric plexus block found no significant effect. No adverse effects of locoregional anesthesia were found.
CONCLUSIONS: Our study showed that TAP blocks, rectus sheath blocks, and paravertebral blocks may decrease opioid consumption and improve pain scores in patients undergoing open abdominal surgery for gynecologic cancer. Additionally, these techniques might serve as a viable alternative for patients with contraindications to epidural analgesia.
摘要：
目的：当硬膜外镇痛不是可行的选择时，在疼痛评分和阿片类药物用量方面，确定哪种局部技术可有效管理妇科大型开腹手术的术后疼痛。
方法：对文献的系统回顾，基于系统评价和荟萃分析(PRISMA)指南的首选项目，进行了。ROB-2评估用于评估偏倚。主要结果是阿片类药物消耗和术后疼痛评分。次要结果包括术后标志物，例如动员时间和排便时间。
结果：共有9项研究（n=714）纳入分析。8项研究的偏倚风险较低。描述了五种不同形式的局部镇痛。八项研究与安慰剂进行了比较，一项研究比较了直肌鞘阻滞与硬膜外镇痛。与安慰剂组相比，调查腹横肌平面（TAP）阻滞的五项研究中的三项显示疼痛评分和阿片类药物消耗有所改善。一项调查直肌鞘块的研究和另一项调查椎旁块的研究表明，在某些时间点，阿片类药物的消耗明显减少，疼痛评分有所改善。研究持续伤口浸润和上腹下丛阻滞的研究没有发现显着效果。未发现局部麻醉的不良反应。
结论：我们的研究表明，TAP阻断，直肌鞘块,和椎旁阻滞可减少妇科癌症开腹手术患者的阿片类药物用量,改善疼痛评分.此外,对于有硬膜外镇痛禁忌症的患者，这些技术可能是一种可行的替代方法。
方法：对文献的系统回顾，基于系统评价和荟萃分析(PRISMA)指南的首选项目，进行了。ROB-2评估用于评估偏倚。主要结果是阿片类药物消耗和术后疼痛评分。次要结果包括术后标志物，例如动员时间和排便时间。
结果：共有9项研究（n=714）纳入分析。8项研究的偏倚风险较低。描述了五种不同形式的局部镇痛。八项研究与安慰剂进行了比较，一项研究比较了直肌鞘阻滞与硬膜外镇痛。与安慰剂组相比，调查腹横肌平面（TAP）阻滞的五项研究中的三项显示疼痛评分和阿片类药物消耗有所改善。一项调查直肌鞘块的研究和另一项调查椎旁块的研究表明，在某些时间点，阿片类药物的消耗明显减少，疼痛评分有所改善。研究持续伤口浸润和上腹下丛阻滞的研究没有发现显着效果。未发现局部麻醉的不良反应。
结论：我们的研究表明，TAP阻断，直肌鞘块,和椎旁阻滞可减少妇科癌症开腹手术患者的阿片类药物用量,改善疼痛评分.此外,对于有硬膜外镇痛禁忌症的患者，这些技术可能是一种可行的替代方法。
