Continuous Wound Infiltration with Local Anesthetic Is an Effective and Safe Postoperative Analgesic Strategy: A Meta-Analysis.
Continuous Wound Infiltration with Local Anesthetic Is an Effective and Safe Postoperative Analgesic Strategy: A Meta-Analysis.
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局部麻醉持续伤口浸润是一种有效且安全的术后镇痛策略：荟萃分析
DOI：
10.1007/s40122-021-00241-4
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发表时间：
2021-06
期刊：
影响因子：
4
通讯作者：
Wang ZN
中科院分区：
文献类型：
--
作者：
Huang XZ;Zhao JH;Gao P;Chen XW;Song YX;Xu Y;Xiao Q;Dai SC;Li JY;Wang ZN
前言术后疼痛管理是围手术期护理的重要组成部分，尤其是对术后恢复的促进作用。局部麻醉药持续伤口渗透(CWI)可能是一种有前途的术后止痛策略。方法系统检索Embase和PubMed数据库，检索相关随机对照试验(RCT)。选择随机对照试验，评价CWI联合局麻药用于术后镇痛的有效性和安全性。结果包括休息和活动时疼痛评分、阿片类药物总消耗量、首次要求急救止痛的时间、住院时间、对止痛的满意程度、肠功能恢复时间、术后恶心呕吐、总并发症、伤口感染、低血压和瘙痒。结果共纳入121项随机对照试验，采用加权平均差法和风险比法分别对连续变量和二分变量进行汇总。局部麻醉组与安慰剂组比较，术后不同时间休息和活动时疼痛减轻，镇痛满意度提高，肠功能恢复时间缩短，恶心呕吐减少，尤其是开腹手术。与硬膜外和静脉止痛相比，这些临床结果没有显著差异。局部麻醉的CWI减少了阿片类药物的总消耗量和低血压风险，并且没有增加总的并发症、伤口感染或瘙痒。在胸骨切开手术中，局麻药CWI具有较好的镇痛效果，且不增加副作用。结论全麻术是一种安全、有效的手术后镇痛方法，可作为促进手术后恢复的一种有前景的止痛方案。
IntroductionPostoperative pain management is an essential module for perioperative care, especially for enhanced recovery after surgery programs. Continuous wound infiltration (CWI) with local anesthetic may be a promising postoperative analgesic strategy. However, its analgesic efficacy and safety remain debatable.MethodsEmbase and PubMed databases were systematically searched for relevant randomized controlled trials (RCTs). RCTs assessing the analgesic efficacy and safety of CWI with local anesthetic for postoperative analgesia were selected. The outcomes contained pain scores during rest and mobilization, total opioid consumption, time to the first request of rescue analgesia, length of hospital stay, satisfaction with analgesia, time to return of bowel function, postoperative nausea and vomiting, total complication, wound infection, hypotension, and pruritus. The weighted mean difference and risk ratio were used to pool continuous and dichotomous variables, respectively.ResultsA total of 121 RCTs were included. CWI with local anesthetic reduced postoperative pain during rest and mobilization at different time points, increased satisfaction with analgesia, shortened recovery of bowel function, and reduced postoperative nausea and vomiting compared with the placebo group, especially for laparotomy surgery. There were no significant differences in these clinical outcomes compared to epidural and intravenous analgesia. CWI with local anesthetic reduced the total opioid consumption and hypotension risk and did not increase total complications, wound infection, or pruritus. CWI with local anesthetic had a better analgesic efficacy without increased side effects for sternotomy surgery. However, CWI with local anesthetic did not translate into favorable analgesic benefits in laparoscopic surgery.ConclusionCWI with local anesthetic is an effective postoperative analgesic strategy with good safety profiles in laparotomy and sternotomy surgery, and thus CWI with local anesthetic may be a promising analgesic option enhancing recovery after surgery programs for these surgeries.
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