Objective To compare the analgesic efficacy of transversus abdominis plane block versus caudal block after lower abdominal surgery in children.MethodsPubMed,EM BASE,Cochrane library,ISI Web of knowledge,Chinese biomedical database,CNKI and Wanfang database were searched for randomized controlled trials involving the postoperative analgesia of transverses abdominis plane(TAP) block and caudal block for lower abdominal surgery in children. The major outcomes of these included studies were pain scores(FLACC scale) and episodes of emesis. Meta-analysis was conducted using RevMan 5.3 software.ResultsFour studies were identified in this meta-analysis.Total of 235 children were included in these randomized controlled trials,and among them there were 118 patients with TAP block and 117 patients with caudal block. It showed that there was no significant difference between TAP block groups and caudal block groups for postoperative pain scores(FLACC scale) at any points of time[6h (P<0.0001),12h(P=0.26),18h(P=0.27),24h(P=0.13)]. The incidence of post-operative emesis was similar between these two groups [OR 0.67,(95% CI 0.13-3.39)].Conclusion Transverses abdominis plane block has the similar postoperative analgesic effect as caudal block, and the postoperative adverse reactions are not influenced.%目的 比较腹横肌平面(TAP)阻滞与骶管麻醉在儿童下腹部手术镇痛的应用价值.方法 计算机检索Cochrane-Library、Pubmed、Embase、Medline、Web of Science、CNKI、万方、维普图书馆数据库,收集TAP和骶管麻醉应用于儿童下腹部手术的随机对照试验(RCT).主要结局指标为术后面部表情评分法(FLACC)评估疼痛,术后呕吐发生率.用Revman 5.3软件进行统计分析.结果系统检索后纳入4篇文献,共235例患儿,其中TAP组患儿118例,骶管麻醉患儿117例.Meta分析结果显示,在术后6h、12h、18h、24h,TAP阻滞和骶管麻醉在儿童下腹部手术后镇痛评分无明显差异[6h(P<0.0001),12h(P=0.26),18h(P=0.27),24h(P=0.13)].患儿术后恶心呕吐发生率两者比较差异均无统计学意义[OR 0.67,(95%CI 0.13-3.39)].结论TAP阻滞与骶管麻醉对儿童下腹部手术后镇痛效果相似,并且不影响术后恶心呕吐发生率,是一种安全、有效的镇痛方法.
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