开放手术后疼痛控制直接影响患者下床活动、肠功能恢复和住院时间。胸段硬膜外镇痛长期被视为重要选择，但低血压、尿潴留、管理复杂度和资源消耗等问题，使临床上一直在寻找更简单、更安全、又不牺牲镇痛效果的方案。腹直肌鞘导管通过局部持续给药提供切口相关镇痛，近年来逐渐受到关注。那么，开放手术后疼痛管理中，腹直肌鞘导管会比胸段硬膜外镇痛更好吗？
下面这篇文献将回答这个问题。
文献英文标题
Rectus sheath catheters versus thoracic epidural analgesia for pain management after open surgery - A systematic review and meta-analysis.
英文摘要要点
Methods:
This systematic review was registered with PROSPERO (CRD420251234467). A systematic PubMed search was conducted to identify studies comparing continuous wound infusion via rectus sheath catheters with thoracic epidural anaesthesia in adult patients undergoing open abdominal, pelvic, thoracic, or vascular surgery. Randomized clinical trials, as well as prospective and retrospective comparative studies, were included. A meta-analysis was performed for randomized trials.
Results:
31 studies (21 prospective, 10 retrospective) involving 2162 patients were included. Rectus sheath catheters and thoracic epidural anaesthesia did not differ significantly with respect to postoperative pain (SMD: -0.35; 95%CI: -2.01-1.32) or opioid consumption (SMD: -0.32; 95%CI: -1.71-1.07). No differences were observed in recovery of bowel function, urinary retention, time to mobilization, or length of hospital stay. Rectus sheath catheters significantly reduced the risk of hypotension compared with thoracic epidural anaesthesia (RR: 0.40; 95%CI: 0.26-0.60) and were associated with lower costs ranging from $500 to $6632 per case. Subgroup analyses suggested less urinary retention and earlier mobilization with rectus sheath catheters in non-visceral surgery and non-laparotomy incisions.
Conclusions:
Rectus sheath catheters provide analgesia comparable to thoracic epidural anaesthesia with fewer complications, facilitating earlier recovery and potential cost savings. Considering the growing shift toward fast-track surgery, rectus sheath catheters represent a pragmatic and resource-efficient alternative for postoperative pain management in open surgical procedures.
文献标题中文翻译
开放手术后疼痛管理中腹直肌鞘导管与胸段硬膜外镇痛的比较：一项系统评价和荟萃分析
文献简介
胸段硬膜外镇痛长期被用于开放手术后的疼痛管理，并常被视为重要参照方案。不过，这一技术可能伴随低血压、尿潴留和恢复延迟等问题，也需要较高的围术期管理资源。腹直肌鞘导管是一种通过切口相关区域持续局部给药来提供镇痛的技术，理论上可能减少部分硬膜外相关不良反应。因此，这篇系统评价和荟萃分析围绕开放手术后疼痛管理，比较了腹直肌鞘导管与胸段硬膜外镇痛在镇痛效果、并发症、恢复指标和费用方面的差异。
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