腹腔手术中前侧腰方肌阻滞于外侧弓状韧带处对疼痛控制的效果：一项系统综述和荟萃分析




贵州医科大学          麻醉与心脏电生理课题组

翻译：赵游霄    编辑：赵游霄        审校：曹莹  

01
背景

 术后腹部手术恢复的一个关键组成部分是术后镇痛的功效。2020年，提出了一种新的腰方肌阻滞（QLB）方法：外侧弓上韧带腰方肌前方肌阻滞（QLB-LSAL）。提出了一种假设，表明阻滞的性能将为腹部手术提供卓越的镇痛效果。该meta分析的主要目的是评估QLB-LSAL在减少术后阿片类药物使用方面的疗效。次要目的是评估该阻滞对术后疼痛相关指标的影响，包括疼痛评分、首次患者自控镇痛 （PCA） 激活的时间以及术后恶心和呕吐 （PONV） 的发生。

02
方法

  对相关数据库进行了全面检索，包括 PubMed、Cochrane 图书馆、EMBASE、Web of Science 等其他相关资源。通过标题和摘要对研究进行初步筛选，随后进行全文筛选。从纳入的研究中提取数据，然后使用 Review Manager 软件（版本 5.4）和 STATA（版本 18.0 平行版）进行分析。


03
结果

     共有 8 项研究参与了此次分析，涉及 596 名参与者。QLB-LSAL 组在术后 24 小时内显著减少了阿片类药物的使用量（平均差异 [MD] = -10.88，95%置信区间 [CI]：-12.37 至 -9.39，P < 0.00001，I2 = 0）。此外，在术后不同时间点还观察到静息疼痛评分的降低。QLB-LSAL 组术后恶心呕吐的发生率显著低于对照组（风险比 [RR] = 0.47，95%置信区间 [CI]：0.32 至 0.69，P < 0.0001，I2 = 41%）。此外，QLB-LSAL 组在术后对辅助止痛药的需求也有所减少（RR = 0.61，95%置信区间 [CI]：0.39 至 0.96，P = 0.03；I2 = 0）。







【罂粟摘要】腹腔手术中前侧腰方肌阻滞于外侧弓状韧带处对疼痛控制的效果：一项系统综述和荟萃分析








04

结论

   在腹腔手术后，采用位于外侧弓状韧带上方的前侧腰方肌阻滞，能显著减少术后 24 小时内的阿片类药物用量，延长首次患者自控镇痛启动的时间，并降低术后恶心呕吐的发生率。

原始文献：

Gong H, Zheng Z, Xu L, et al. Efficacy of anterior quadratus lumborum block at the lateral supra-arcuate ligament for pain control in abdominal surgery: a systematic review and meta-analysis [J]. BMC Anesthesiology, 2025, 25(1).

英文原文：

Efficacy of anterior quadratus lumborum block at the lateral supra-arcuate ligament for pain control in abdominal surgery: a systematic review and meta-analysis

Abstract 

Background: A critical component of postoperative abdominal surgery recovery is the efficacy of analgesia administered postsurgery. In 2020, a novel approach to the quadratus lumborum block (QLB) was proposed: anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL). A hypothesis indicating that the performance of the block would provide superior analgesia for abdominal surgery was developed. The primary aim of this meta-analysis was to assess the efficacy of the QLB-LSAL in reducing postoperative opioid use. The secondary objective was to assess the effects of this block on postoperative pain-related indicators, including pain scores, time to first patient-controlled analgesia (PCA) activation, and the occurrence of postoperative nausea and vomiting (PONV).

Methods: A comprehensive search of relevant databases, including PubMed, the Cochrane Library, EMBASE, Web of Science, and other relevant sources, was conducted. Studies were screened for broad eligibility by title and abstract, followed by full-text screening. Data were extracted from the included studies and then analyzed via Review Manager software (version 5.4) and STATA (version 18.0 MP-Parallel Edition).

Results: A total of eight studies involving 596 participants were included in the analysis. The QLB-LSAL group demonstrated a statistically significant reduction in postoperative opioid consumption within the first 24 h (mean difference [MD] = – 10.88, 95% confidence interval [CI]: – 12.37 to – 9.39, P < 0.00001, I2 = 0). Additionally, reduced pain scores at rest were observed at various time points postoperatively. The incidence of postoperative nausea and vomiting in the QLB-LSAL group was significantly lower than that in the control group (risk ratio [RR] = 0.47, 95% CI: 0.32 to 0.69, P < 0.0001, I2 = 41%). Additionally, the QLB-LSAL group exhibited a reduced need for postoperative rescue analgesia (RR = 0.61, 95% CI: 0.39 to 0.96, P = 0.03; I2 = 0).

Conclusions: The anterior quadratus lumborum block at the lateral supra-arcuate ligament significantly provides less 24-h postoperative opioid consumption after abdominal surgery, prolongs the time to first patient-controlled analgesia activation, and lowers the incidence of postoperative nausea and vomiting.

END