The purpose of this article is to evaluate the postoperative analgesic effect and incidence of adverse reactions of ultrasound-guided quadrilateral ligament block (QLB) in patients undergoing abdominal surgery using meta-analysis and systematic evaluation methods. Pub Med, Cochrane Library, EMBase, China National Knowledge Infrastructure, Wanfang Database, VIP Network, and China Biomedical Full text Database were searched from database establishment to January 10, 2024. Randomized controlled trials (RCTs) were collected on the analgesic effect of QLB on the arcuate ligament under ultrasound guidance for abdominal surgery, with the control group receiving simple general anesthesia. The experimental group patients were treated with QLB combined general anesthesia on the arcuate ligament under ultrasound guidance. The main outcome measures were resting state pain scores at 1 hour, 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively, as well as motor state pain scores at 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively. The secondary outcome measure was the amount of propofol, sufentanil, and remifentanil used during surgery; The number of cases of rescue analgesia and the number of effective compressions of the analgesic pump within 48 hours after surgery; The incidence of postoperative nausea, vomiting, dizziness, pruritus, respiratory depression and urinary retention; Awakening time, first time out of bed, first time passing gas, and length of hospital stay. Perform meta-analysis on the data using Rev Man 5.4 software. A total of 8 RCT studies were included, with a total of 556 cases, including 278 cases in the control group and 278 cases in the experimental group. The meta-analysis results showed that compared with the control group, the experimental group had 1 hour (MD=-1.65, 95% CI -1.90-1.41, P<0.0001), 2 hours (MD=-3.10, 95% CI -3.25-2.95, P<0.0001), 6 hours (MD=-2.85, 95% CI -2.99-2.71, P<0.0001), 12 hours (MD=-3.24, 95% CI -3.34-3.14, P<0.0001), 24 hours (MD=-3.15, 95% CI -3.25-3.06, P<0.0001), and 48 hours (MD=-0.46, 95% CI -3.25-3.06, P<0.0001) after surgery.% CI -0.47~-0.45, P<0.0001) Resting state pain score and postoperative 2 hours (MD=-2.17, 95% CI -2.43-1.92, P<0.0001), 6 hours (MD=-1.89, 95% CI -2.10-1.69, P<0.0001), 12 hours (MD=-1.58, 95% CI -1.79-1.37, P<0.0001), 24 hours (MD=-1.07, 95% CI -1.24-0.90, P<0.0001), 48 hours (MD=-0.81, 95% CI -1.00-0.61, P<0.0001), exercise state pain score and intraoperative propofol (MD=-70.17, 95% CI -0.90, P<0.0001) -73.31 to -67.03, P<0.0001) Sufentanil (MD=-10.56, 95% CI -11.43-9.69, P<0.0001), remifentanil dosage (MD=-0.45, 95% CI -0.48-0.42, P<0.0001), number of rescue analgesia cases at 48 hours post surgery (RR=0.09, 95% CI 0.04-0.20, P<0.0001), effective number of pump presses at 48 hours post surgery (MD=-5.10, 95% CI -5.56-4.64, P<0.0001), incidence of postoperative nausea and vomiting (RR=0.13, 95% CI 0.07-0.23, P<0.0001) The incidence rate of postoperative urinary retention was significantly lower (RR=0.14, 95% CI 0.05 ~ 0.42, P=0.0005), the time to wake up after surgery (MD=-4.97, 95% CI -5.92 ~ 4.01, P<0.0001), the time to first get out of bed after surgery (MD=-7.19, 95% CI -8.12 ~ -6.27, P<0.0001), the time to first exhaust after surgery (MD=-10.13, 95% CI -11.99 ~ -8.28, P<0.0001), and the time to stay in hospital (MD=-1.07, 95% CI -1.33 ~ -0.82, P<0.0001). There was no statistically significant difference in the incidence of postoperative dizziness (RR=0.38, 95% CI 0.14-0.99, P=0.05), itching (RR=0.33, 95% CI 0.05-2.12, P=0.24), and respiratory depression (RR=0.17, 95% CI 0.02-1.86, P=0.15) between the two groups of patients.The existing clinical evidence shows that ultrasound guided QLB combined with general anesthesia on the arcuate ligament is better than general anesthesia alone for postoperative analgesia in abdominal surgery. It can reduce the amount of anesthesia, nausea, vomiting, urinary retention and other adverse reactions during the operation, shorten the time of recovery, the time of the first next time, the time of the first exhaust and the time of hospitalization, and accelerate the postoperative recovery of patients.

Fang Xin, Liang Yu. Meta analysis of ultrasound-guided lumbar quadratus muscle block on the arcuate ligament for postoperative pain relief and adverse reactions in abdominal surgery. Academic Journal of Medicine & Health Sciences (2024), Vol. 5, Issue 4: 1-12. https://doi.org/10.25236/AJMHS.2024.050401.

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