Журнал «Медицина неотложных состояний» Том 21, №4, 2025

Актуальність. Післяопераційний біль після лапароскопічної холецистектомії (ЛХЕ) залишається важливою клінічною проблемою. Лапароскопічна блокада поперечної площини живота (Л-БППЖ) та ультразвукова блокада (УС-БППЖ, тобто за допомогою ультрасонографії) широко застосовуються для знеболювання після ЛХЕ. Проте їхня порівняльна ефективність досі викликає дискусії. Матеріали та методи. У базах даних PubMed, Scopus і Cochrane було проведено систематичний пошук рандомізованих досліджень, опублікованих до січня 2025 року, які порівнювали ефективність БППЖ під ультразвуковим і лапароскопічним контролем. Оцінювали такі результати: інтенсивність післяопераційного болю за ВАШ, тривалість операції, час до першої потреби у знеболювальних засобах, післяопераційне споживання морфіну, частоту післяопераційної нудоти і блювання (ПОНБ), час до першого відходження газів та першого випорожнення. Ризик упере­дженості аналізували за допомогою інструменту Cochrane Risk of Bias (RoB-2), а статистичну обробку даних виконували за допомогою програмного забезпечення IBM SPSS Statistics 30.0. Результати. До аналізу включено 10 рандомізованих досліджень. Л-БППЖ ефективно зменшує інтенсивність післяопераційного болю після ЛХЕ, відкладаючи потребу в додатковому знеболюванні. Однак цей ефект не спостерігався на шостій годині після операції. Інші досліджувані параметри, як-от частота ПОНБ і час до відновлення моторики кишечника, не зазнали статистично значимих змін. Водночас статистично значущих відмінностей між Л-БППЖ та УС-БППЖ за такими параметрами, як інтенсивність болю через 1, 6, 12 та 24 години після операції, тривалість втручання, час до першої потреби в аналгетиках, післяопераційне споживання морфіну, частота ПОНБ, час до першого відходження газів і першого випорожнення, не виявлено. Л-БППЖ, виконана на початку операції, ефективніше знижує інтенсивність післяопераційного болю. Аналіз показав значну гетерогенність досліджень, але загалом низький ризик упередженості в оцінці їхньої якості. Висновки. Проведений метааналіз підтвердив ефективність Л-БППЖ у зниженні післяопераційного болю та пов’язаних із ним результатів після ЛХЕ. Проте жодних доказів переваги УС-БППЖ над Л-БППЖ у лікуванні післяопераційного болю не виявлено. Для підтвердження та підтримки цих висновків необхідні додаткові рандомізовані клінічні дослідження.

Background. Postoperative pain following laparoscopic cholecystectomy remains a significant clinical issue. Laparoscopic (L-TAPB) and ultrasound-guided transverse abdominis plane block (US-TAPB) are widely used for postoperative analgesia in laparoscopic cholecystectomy. However, their comparative effectiveness remains a subject of debate. Materials and methods. A systematic search for randomized controlled trials published up to January 2025 that compared TAPB under ultrasound and laparoscopic guidance was performed in PubMed, Scopus, and Cochrane databases. The outcomes evaluated included the intensity of postoperative pain using the visual analogue scale, duration of surgery, time to the first analgesic requirement, postoperative morphine consumption, frequency of postoperative nausea and vomiting (PONV), time to first flatus, and time to first bowel evacuation. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB-2), and statistical analysis was performed using IBM SPSS Statistics 30.0 software. Results. Ten randomized controlled trials were included in the analysis. L-TAPB effectively reduces the intensity of postoperative pain after laparoscopic cholecystectomy, delaying the need for additional analgesia. However, this effect was not observed six hours post-surgery. Other parameters studied, such as PONV frequency and time to bowel function recovery, did not show statistically significant changes. At the same time, no statistically significant differences were observed between L-TAPB and US-TAPB regarding pain intensity at 1, 6, 12, and 24 hours postoperatively, duration of surgery, time to the first analgesic requirement, postoperative morphine consumption, PONV frequency, time to first flatus, and time to first bowel evacuation. L-TAPB, performed at the beginning of the surgery, more effectively reduces the intensity of postoperative pain. The analysis showed significant heterogeneity of studies, but overall low risk of bias in assessing their quality. Conclusions. This meta-analysis confirmed the effectiveness of L-TAPB in alleviating postoperative pain and associated factors after laparoscopic cholecystectomy. However, it did not demonstrate any advantage of US-TAPB over L-TAPB in managing postoperative pain. Further randomized clinical trials are required to validate and support these findings.

лапароскопічна холецистектомія; післяопераційний біль; блокада поперечної площини живота; огляд, метааналіз

laparoscopic cholecystectomy; postoperative pain; transversе abdominis plane block; review; meta-analysis

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