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KMID : 0356920230760010034
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Korean Journal of Anesthesiology
2023 Volume.76 No. 1 p.34 ~ p.46
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Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis
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Cassai Alessandro De
Sella Nicolo
Geraldini Federico
Tulgar Serkan
Ahiskalioglu Ali
Boscolo Annalisa
Navalesi Paolo
Dost Burhan
Manfrin Silvia
Karapinar Yunus Emre
Paganini Greta
Beldagli Muzeyyen
Luoni Vittoria
Ordulu Busra Burcu Kucuk
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Abstract
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Background : Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach.
Methods : We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials.
Results : A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (?1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (?1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV.
Conclusions : RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.
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KEYWORD
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Cholecystectomy, Conduction anesthesia, Laparoscopic cholecystectomy, Laparoscopy, Local anesthesia, Meta-analysis.
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