Comparison Of Transversus Abdominis Plane Block And Quadratus Lumbounm Block For Pain Relief After Abdominal Surgery

Background:Along with the development of nerve block techniques,trunk nerve blocks including transversus abdominis plane block(TAPB),quadratus lumborum block(QLB),intercostal nerve block,paravertebral Block and rectus sheath block has gained increasing attention in recent years.Transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)have been used for the postoperative analgesia of abdominal surgery including cesarean section and hernia repair.Objective:To compare the efficacy and safety of transversus abdominis plane block(TAPB)with quadratus lumborum block(QLB)used for the postoperative analgesia of abdominal surgery by the method of Meta analysisMethods:According to retrieval strategy,PubMed,The Cochrane Library,Embase,Web of Science,CNKI,WANFANG DATA,CQVIP Database and Chinese Biomedical Literature Database were used.On the basis of the criteria of inclusion and exclusion,randomized controlled trials for comparison of the efficacy and safety of transversus abdominis plane block(TAPB)with quadratus lumborum block(QLB)used for the postoperative analgesia of abdominal surgery were screened out.Cochrane system evaluation handbook and the Review Manager 5.3 software were used to conduct quality assessment of selected articles and Meta analysis of incorporated literature,respectively.The main outcome indicator was the consumption of opioid analgesics 24 hours after surgery.Other outcome indicators included:postoperative pain score at 12h and 24 h,the time to first use of analgesic drugs,the number of patients requiring remedial use of additional analgesics after surgery,and the incidence of postoperative adverse reactions such as postoperative nausea and vomiting(PONV)and dizziness Results:A total of 382 articles were retrieved.After screening,16 articles were included,including 5 English articles and 11 Chinese articles,with a total of 1,200 patients were identified in our study.The analysis results showed that compared to the TAP group,the QLB group had less opioid analgesics consumption at 24 hour after abdominal surgery,and the difference was statistically significant with the morphine consumption(MD=3.95,95%Cl:0.84-7.06,p=0.01)and the consumption of sufentanil(MD=23.74,95%CI:15.131-32.17,p<0.00001).The QLB group had a longer time to first use of analgesics after surgery(SMD=8.66,95%CI:-12.62-4.7,p<0.0001).The number of patients using remedial analgesics after surgery was fewer than that of the TAP group with statistically significant difference(OR=4.70,95%CI:2.86-7.73,p<0.00001).In addition,compared to the TAP group,the QLB group at 12 hour(MD=0.73,95%CI:0.22-1.25,p=0.005)and 24 hour(MD=0.48,95%Cl:0.11-0.84,p=0.01)after abdominal surgery had a lower pain score and the difference was statistically significant.In terms of postoperative adverse reactions,the QLB group was able to effectively reduce the incidence of postoperative nausea and vomiting(OR=3.21,95%CI:1.91-5.39,p<0.0001)and dizziness(OR=3.52,95%Cl:1.77-7.01,p=0.0003)compared to the TAP group,and the difference was statistically significant.Subgroup analysis suggested that for laparoscopic surgery,there was no satistical difference(MD=0.01,95%CI:-0.16-0.18,p=0.90)in pain score between the two groups at 12h and 24h after surgery.However,for non-laparoscopic surgery,the difference was statistically significant(MD=0.20,95%CI:0.01-0.39,p=0.04).Subgroup analysis of the timing of nerve block showed that the comparison of pain scores at 12 and 24 hour after surgery was the same in the two groups whether the intervention was performed before or after surgery,and the difference was statistically significant(p<0.05).In addition,compared to the TAP group,the opioid analgesics consumption at 24 h after cesarean section in the QLB group was lower,and the difference was statistically significant(SMD=1.05,95%CI:0.77-1.34,p<0.00001).Conclusion:Transversus abdominis plane block(TAPB)or quadratus lumborum block(QLB)can be used for postoperative analgesia of abdominal surgery whether the intervention was performed before or after surgery.In addition,the analgesic efficiency and safety of quadratus lumbosum block is better,especially for non-laparoscopic surgery including cesarean section.However,the conclusions need to be interpreted with caution due to a high level of heterogeneity among these studies.