The purpose of this article is to compare the analgesic effects and adverse reactions of ultrasound-guided quadratus lumborum block (QLB) and traditional QLB in abdominal surgery patients using meta-analysis and systematic evaluation methods.Computer searches were conducted on PubMed, Embase, Ovid, Web of Science, Cochrane Library, CNKI, VIP Database, Wanfang Database, and China Biomedical Full text Database. The search was conducted from the establishment of the database to January 10, 2024. A randomized controlled trial (RCT) was conducted to compare the analgesic effects of ultrasound-guided QLB on the arcuate ligament and traditional QLB on abdominal surgery. The main outcome measure was the resting and motor pain scores at 1, 2, 4, 6, 8, 12, 24, and 48 hours postoperatively. The secondary outcome measures were intraoperative remifentanil and postoperative 24-hour morphine use; the number of cases of salvage analgesia and the time of first press of the analgesic pump within 24 hours after surgery; the incidence of postoperative nausea, vomiting, and itching; first time out of bed, first exhaust time, length of hospital stay, and satisfaction score. Perform statistical analysis on the data using RevMan 5.4 software. A total of 7 RCT studies were included, with a total of 514 cases, including 256 cases in the QLB group on the arcuate ligament under ultrasound guidance (experimental group) and 258 cases in the traditional QLB group under ultrasound guidance (control group). The results of Meta-analysis showed that compared with the control group, the resting pain scores at 1h after surgery (MD=-0.90, 95%CI -1.00--0.81, P<0.00001), 2h after surgery (MD=-0.81, 95%CI -1.32--0.29, P=0.002), 4h after surgery (MD=-0.27, 95%CI -0.40--0.15, P<0.00001), 6h after surgery (MD=-0.40, 95%CI -0.70--0.10, P=0.009), 8h after surgery (MD=-0.55, 95%CI -0.76--0.34, P<0.00001), 12h after surgery (MD=-1.13, 95%CI -1.26-0.99, P<0.00001), 24h after surgery (MD=-0.61, 95%CI -0.74-0.48, P<0.00001), 2h after surgery (MD=-0.39, 95%CI -0.61--0.17, P=0.004), 24h after surgery (MD=-0.21, 95%CI -0.38-0.05, P=0.01), intraoperative consumption of remifentanil (MD=-0.13, 95%CI -0.24--0.03, P=0.01), 24h after surgery consumption of morphine (MD=10.91, 95%CI -12.68--9.14, P<0.00001), incidence of postoperative nausea and vomiting (RR=0.45, 95%CI 0.24-0.83, P=0.01), first time out of bed (MD=-1.16, 95%CI -1.56--0.75, P<0.00001), first time exhaust time (MD=14.00, 95%CI 13.54-14.47, P<0.00001), first time pressing time of analgesia pump (MD=4.01, 95%CI 3.04-4.97, P<0.00001), and satisfaction score (MD=-1.09, 95%CI -1.42--0.76, P<0.00001) in the experimental group were significantly decreased; the first time pressing time of analgesia pump (MD=4.01, 95%CI 3.04-4.97, P<0.00001) and satisfaction score (MD=-1.09, 95%CI -1.42--0.76, P<0.00001) were significantly increased. There was no significant difference in resting pain score 48 h after surgery (MD=-0.00, 95%CI -0.00-0.00, P=0.76), exercise pain score 4 h after surgery (MD=-0.00, 95%CI -0.00--0.00, P=1.00), exercise pain score 6 h after surgery (MD=-0.28, 95%CI -0.59--0.02, P=0.07), exercise pain score 8 h after surgery (MD=-0.03, 95%CI -0.32-0.26, P=0.84), exercise pain score 12 h after surgery (MD=-0.16, 95%CI -0.35-0.03, P=0.11), exercise pain score 48 h after surgery (MD=-0.00, 95%CI -0.25-0.25, P=0.97), number of cases requiring rescue analgesia 24 h after surgery (RR=0.55, 95%CI 0.28-1.08, P=0.08), incidence of postoperative pruritus (RR=0.83, 95%CI 0.25-2.78, P=0.76), satisfaction score (MD=-1.09, 95%CI -1.42--0.76, P<0.00001) and length of hospital stay (MD=0.00, 95%CI -0.24--0.24, P=1.00) between the two groups. Existing evidence suggests that ultrasound-guided QLB on the arcuate ligament is more effective than traditional QLB for postoperative pain relief in abdominal surgery, while accelerating rapid postoperative recovery without increasing the incidence of adverse reactions.

Fang Xin, Liang Yu. Meta analysis of ultrasound-guided lumbar quadratus muscle block and traditional lumbar quadratus muscle block for postoperative pain relief and adverse reactions in abdominal surgery. International Journal of Frontiers in Medicine (2024), Vol. 6, Issue 4: 9-20. https://doi.org/10.25236/IJFM.2024.060402.

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