Abstract: Objective To systematically evaluate the effect of quadratus lumborum block （QLB） on the postoperative analgesia in puerperae undergoing cesarean section. Methods Databases including PubMed, The Cochrane Library, Embase, CBM, Wanfang Data, CNKI, VIP were searched to collect randomized controlled trials （RCTs） about QLB on the postoperative analgesia in puerperae undergoing cesarean section from inception to February 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 10 RCTs studies involving 666 patients were included. The results of meta-analysis showed that, compared with the control group, QLB could reduce the 24-hour opioid requirements （SMD=-1.63, 95%CI： -2.06, -1.20, P<0.00001）, lower the 24-hour PCA demands （SMD=-2.01, 95%CI： -2.35, -1.68, P<0.00001）, and there was no increase in the incidence of opioid-related complications. Several studies reported that QLB on the VAS score at rest and during movement at 24-hour, but quantitative analysis was not possible due to high heterogeneity, and we had conducted only a descriptive analysis of these results. Conclusion The use of QLB for postoperative analgesia in puerperae undergoing cesarean section could reduce the requirements of opioid analgesics, lower the 24-hour PCA demands. It has a widely prospect in the application of multimode analgesia in patients.

Key words: quadratus lumborum block, cesarean section, postoperative analgesia, randomized controlled trial, meta analysis

摘要： 目的 系统评价腰方肌阻滞应用于剖宫产手术术后镇痛的有效性和安全性。方法 计算机检索PubMed、The Cochrane Library、Embase、中国生物医学数据库（CBM）、万方数据库、中国知网和维普网数据库,收集从建库到2020年4月所有关于腰方肌阻滞用于剖宫产手术术后镇痛效果的随机对照试验。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 最终纳入10个随机对照试验,包括666例患者。Meta分析结果显示：与对照组相比,腰方肌阻滞能有效降低剖宫产患者术后24小时内阿片类药物的需求量（SMD=-1.63, 95%CI： -2.06, -1.20, P<0.00001）,同时降低术后24小时内PCA按压次数（SMD=-2.01, 95%CI： -2.35, -1.68, P<0.00001）,且不增加阿片类药物相关的并发症发生率。由于各研究间术后24小时静息和运动时VAS评分的高异质性,无法进行定量分析,我们仅对此结果进行了描述性分析。结论 腰方肌阻滞用于剖宫产术术后镇痛,能降低术后阿片类药物用量,降低术后24小时PCA按压次数,在临床多模式镇痛的应用中有广泛前景。

关键词: 腰方肌阻滞, 剖宫产术, 术后镇痛, 随机对照试验, 系统评价