超声引导下弓状韧带上腰方肌阻滞在腹腔镜 全子宫切除术中镇痛效果的Meta分析

Meta-Analysis of the Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block via the Supra-Arcuate Ligament Approach in Total Laparoscopic Hysterectomy

摘要: 目的：系统评价超声引导下弓状韧带上腰方肌阻滞(quadratus lumborum block via the supra-arcuate ligament approach, QLB-LSAL)在腹腔镜全子宫切除术中镇痛效果及其对围术期麻醉药物使用的影响。方法：计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网(CNKI)、万方数据库及维普数据库，检索时限为2016年1月至2026年1月，收集超声引导下QLB-LSAL用于腹腔镜全子宫切除术的随机对照试验。由2名研究者独立进行文献筛选、数据提取及偏倚风险评价，采用RevMan 5.3软件进行Meta分析。主要结局指标为术后24 h静息视觉模拟评分(VAS)，次要结局指标包括术后12 h静息VAS评分、术后48 h补救镇痛次数及术中瑞芬太尼总用量。结果：共纳入3项随机对照试验，共302例患者。Meta分析结果显示，与对照组相比，QLB-LSAL组术后24 h静息VAS评分显著降低(MD = −2.81, 95% CI: −4.25~−1.37, P = 0.0001)，术后12 h静息VAS评分亦显著降低(MD = −2.81, 95% CI: −4.38~−1.25, P = 0.0004)；术后48 h补救镇痛次数显著减少(MD = −2.20, 95% CI: −2.39~−2.01, P < 0.00001)；术中瑞芬太尼总用量显著减少(MD = −0.40, 95% CI: −0.56~−0.24, P < 0.00001)。结论：超声引导下QLB-LSAL可有效减轻腹腔镜全子宫切除术患者术后疼痛，减少补救镇痛需求及术中阿片类药物用量，具有一定临床应用价值。但受纳入研究数量及质量限制，仍需更多高质量随机对照试验进一步证实。

Abstract: Objective: To systematically evaluate the analgesic efficacy of ultrasound-guided quadratus lumborum block via the supra-arcuate ligament approach (QLB-LSAL) in total laparoscopic hysterectomy and its effects on perioperative anesthetic drug use. Methods: Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database were searched for randomized controlled trials on ultrasound-guided QLB-LSAL in total laparoscopic hysterectomy from January 2016 to January 2026. Two reviewers independently performed literature screening, data extraction, and risk-of-bias assessment. Meta-analysis was conducted using RevMan 5.3. The primary outcome was the resting visual analogue scale (VAS) score at 24 h postoperatively. Secondary outcomes included the resting VAS score at 12 h postoperatively, the number of rescue analgesia episodes within 48 h after surgery, and intraoperative remifentanil consumption. Results: A total of 3 randomized controlled trials involving 302 patients were included. The meta-analysis showed that compared with the control group, the QLB-LSAL group had significantly lower resting VAS scores at 24 h postoperatively (MD = −2.81, 95% CI: −4.25 to −1.37, P = 0.0001) and at 12 h postoperatively (MD = −2.81, 95% CI: −4.38 to −1.25, P = 0.0004). In addition, the number of rescue analgesia episodes within 48 h after surgery was significantly reduced (MD = −2.20, 95% CI: −2.39 to −2.01, P < 0.00001), and intraoperative remifentanil consumption was significantly lower (MD = −0.40, 95% CI: −0.56 to −0.24, P < 0.00001). Conclusion: Ultrasound-guided QLB-LSAL can effectively reduce postoperative pain, rescue analgesic requirements, and intraoperative opioid consumption in patients undergoing total laparoscopic hysterectomy, indicating potential clinical value. However, due to the limited number and quality of the included studies, more high-quality randomized controlled trials are still needed for further validation.