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Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta-analysis of randomised controlled trials
Anaesthesia ( IF 10.7 ) Pub Date : 2021-12-27 , DOI: 10.1111/anae.15645
N P Singh 1 , D Monks 2 , J K Makkar 3 , A Palanisamy 2 , P Sultan 4 , P M Singh 2
Affiliation  

Caesarean delivery is common and can cause severe postoperative pain but injection of local anaesthetic at various sites for regional blocks or local anaesthetic infiltration may reduce this. We aimed to compare and rank these sites. We searched PubMed, Google Scholar, EMBASE and CENTRAL to June 2021 for randomised controlled trials and performed a random-effects Bayesian model network meta-analysis. The primary outcome was dose of parenteral morphine equivalents in the first 24 postoperative hours. We used surface under cumulative ranking probabilities to order techniques. We analysed 114 trials (8730 participants). The ordered mean (95% credible interval) reduction in morphine equivalents, from 34 mg with placebo, were as follows: ilio-inguinal 15 (1–32) mg; ilio-inguinal–iliohypogastric 13 (6–19) mg; transversalis fascia 11 (4–26) mg; erector spinae 11 (10–32); transverse abdominis 9 (4–13) mg; wound catheter infusion 8 (2–15) mg; quadratus lumborum 8 (1–15) mg; wound infiltration 8 (2–13) mg; and no intervention −4 (−10 to 2) mg. Ordered efficacies for injection sites were different for other relevant outcomes, including pain (to 4–6 h and to 24 h) and time to rescue analgesia: there was no single preferred route of injection. The ordered mean (95% credible interval) reduction in dynamic pain scores (0–10 scale) at 24 h compared with placebo were as follows: wound infusion 1.2 (0.2–2.1); erector spinae 1.3 (−0.5 to 3.1); quadratus lumborum 1.0 (0.1–1.8); ilio-inguinal–iliohypogastric 0.6 (−0.5 to 1.8); transverse abdominis 0.6 (−0.1 to 1.2); wound infiltration 0.5 (−0.3 to 1.3); transversalis fascia −0.8 (−3.4 to 1.9); ilio-inguinal −0.9 (−3.6 to 1.7); and no intervention −0.8 (−1.8 to 0.2). We categorised our confidence in effect sizes as low or very low.

中文翻译:

剖宫产后局部阻滞或局麻药浸润镇痛的疗效:随机对照试验的网络荟萃分析

剖腹产很常见,可能会导致严重的术后疼痛,但在不同部位注射局部麻醉剂以进行局部阻滞或局部麻醉剂浸润可能会减轻这种情况。我们旨在对这些网站进行比较和排名。我们检索了 PubMed、Google Scholar、EMBASE 和 CENTRAL 至 2021 年 6 月的随机对照试验,并进行了随机效应贝叶斯模型网络荟萃分析。主要结果是术后前 24 小时的肠胃外吗啡当量剂量。我们使用累积排名概率下的表面来排序技术。我们分析了 114 项试验(8730 名参与者)。吗啡当量的有序平均(95% 可信区间)从安慰剂组 34 mg 减少如下:髂腹股沟 15 (1-32) mg;髂腹股沟-髂腹下 13 (6-19) 毫克; 横筋膜 11 (4-26) 毫克; 竖脊肌 11 (10-32); 腹横肌 9 (4-13) 毫克; 伤口导管输液 8 (2-15) mg; 腰方肌 8 (1-15) 毫克; 伤口浸润 8 (2-13) mg; 无干预 -4(-10 至 2)mg。对于其他相关结果,包括疼痛(至 4-6 小时和至 24 小时)和挽救镇痛的时间,注射部位的有序疗效不同:没有单一的首选注射途径。与安慰剂相比,24 小时动态疼痛评分(0-10 分)的有序平均(95% 可信区间)降低如下:伤口输液 1.2(0.2-2.1);竖脊肌 1.3(-0.5 至 3.1);腰方肌 1.0 (0.1–1.8); 髂腹股沟-髂下腹 0.6(-0.5 至 1.8);腹横肌 0.6(-0.1 至 1.2);伤口浸润 0.5(-0.3 至 1.3);横筋膜 -0.8(-3.4 至 1.9);髂腹股沟 -0.9(-3.6 至 1.7);并且没有干预-0。8(-1.8 到 0.2)。我们将我们对效应大小的信心分类为低或非常低。
更新日期:2021-12-27
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