Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis

Peltrini, Roberto; Cantoni, Valeria; Green, R; Greco, Paola Antonella; Calabria, Mariarosaria; Bucci, Luigi; Corcione, Francesco

doi:10.1007/s10151-020-02206-9

Cited by 40 publications

(22 citation statements)

References 65 publications

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“…Finally, we retained 11 RCTs [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] and one systematic review with meta-analysis [ 2 ] that met inclusion and exclusion criteria published between 2007 and 2018. Forty-four studies were excluded with reasons: six studies were meta-analysis including rectal resection [ 9 , [26] , [27] , [28] , [29] , [30] ], seven RCTs including patients undergoing only open colorectal surgery [ [31] , [32] , [33] , [34] , [35] , [36] , [37] ], four RCTs were included in the retained meta-analysis [ [38] , [39] , [40] , [41] ], twenty RCTs assessed rectal surgery, one RCT compared two different approaches of the same analgesic technique [ 42 ] and four non-randomized trials [ [43] , [44] , [45] , [46] ]. Table 1 , Table 2 summarise the included meta-analysis and RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…In 2010, a Cochrane Review showed that TAP block reduced opioid consumption during the first 48 h postoperatively following abdominal surgery; however, it was based on moderately sized studies with significant heterogeneity [ 57 ]. A recent systemic review and meta-analysis, published by Peltrini et al [ 9 ], found that TAP block provided a reduction in pain scores and a significant decrease in morphine consumption on the first postoperative day without increasing complications. Another meta-analysis, including six RCTs, compared TAP block to epidural analgesia in colorectal surgery, showed that TAP block was equivalent to TEA in postoperative pain management and improved functional recovery, especially in laparoscopic surgery [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

Daghmouri

Chaouch

Oueslati

et al. 2021

Annals of Medicine and Surgery

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Introduction Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients. Methods We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine. Results Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia. Conclusions Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

Daghmouri

Chaouch

Oueslati

et al. 2021

Annals of Medicine and Surgery

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“…Brogi, et al, ( 56) looked at all abdominal surgeries (n = 51), including three bariatric surgery trials. Within reviews that focussed on colonic surgeries, there is consistent evidence to suggest that TAP block reduces pain scores and also decreases opioid consumption, although the actual effect size has varied (57,58). From a clinical perspective, there are 2 important considerations: are these outcomes sufficient to recommend routine use; and are there any drawbacks.…”

Section: Discussionmentioning

confidence: 99%

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021

Pain Phys

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BACKGROUND: Patients undergoing bariatric surgery present unique analgesic challenges, including poorly controlled pain, increased prevalence of obstructive sleep apnea, and opioid-induced respiratory depression. The transversus abdominis plane (TAP) has been demonstrated to be a safe and effective component of multimodal analgesia for a variety of abdominal surgeries. OBJECTIVE: To determine the benefits of the TAP block on postoperative analgesia and recovery in patients undergoing bariatric surgery. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to April 2020 for studies using TAP block in bariatric surgeries and reporting postoperative pain, opioid consumption, and recovery-related outcomes. Primary outcomes included postoperative pain scores, opioid consumption, and recovery-related outcomes (e.g., length of stay, time to ambulation). Outcomes were pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-one studies (15 RCTs [n = 1410] and 6 nonrandomized studies [n = 1959]) were included. Among RCTs, the TAP block group required fewer opioid rescues (RR 0.28; 95% CI 0.18 to 0.42, P < 0.001) (moderate quality); reduced total opioid use over 24 hours (MD –8.33; 95% CI –14.78 to –1.89, P = 0.01); decreased time to ambulation (MD –1.12 hours; 95% CI –1.50 to –0.73, P < 0.001) (high quality); and had significantly lower pain scores at 6 hours (MD –1.52; 95% CI –1.90 to –1.13, P < 0.01) and 12 hours (MD –0.95; 95% CI –1.34 to –0.56, P < 0.001) on a 0-10 pain scale (moderate quality). No difference was observed for nausea and vomiting, or hospital length of stay. Meta-analyzed outcomes from observational studies supported these results, suggesting decreased postoperative pain and opioid consumption. LIMITATIONS: Studies varied with respect to type of surgery and components of comparator multimodal analgesia, likely contributing to heterogeneity. Subgroup analyses by type of comparator group were conducted to address these differences. We were unable to extract data from all trials included due to variability in outcomes reporting, such as non-opioid drugs for postoperative pain management or invalid dosages. Pain-related outcomes may be affected by operative differences leading to variation in visceral pain. Observational studies have their inherent limitations, such as confounding due to lack of participant randomization and intervention blinding, potentially affecting subjective outcomes, such as pain scores, as well as provider-dependent outcomes, such as hospital length of stay. Lastly, there was significant variation of TAP block technique across all studies. CONCLUSION: TAP block is an effective, safe modality that can be performed under anesthesia. It decreases pain, opioid use, and time to ambulation after bariatric surgeries and should be considered in multimodal analgesia for enhanced recovery in this high-risk surgical population. KEY WORDS: Analgesia, bariatric surgery, enhanced recovery after surgery, multimodal analgesia, opioid-sparing analgesia, pain, postoperative, regional block, transversus abdominis plane block

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“…In a recent meta-analysis, Peltrini et al have evaluated the efficacy of TAP block in colorectal surgery and concluded that it provides effective analgesia and reduces postoperative opioid consumption in the first 24 hours without any significant complications. 8 Different concentrations of the same LA and/or different local anesthetics have been used in the TAP block. Raghunath et al observed that 0.5% Ropivacaine provided a longer duration of analgesia as compared to 0.25% Levobupivacaine in patients undergoing lower abdominal surgeries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of ropivacaine and bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing elective lower abdominal surgeries - A randomized double-blind trial

Sharma¹,

Banerjee²,

Jain³

et al. 2021

IJCA

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Ultrasound-guided Transversus Abdominal Plane (TAP) block is an effective and safe regional anaesthesia technique. Our study is aimed to draw a comparison between the analgesic efficacy of Ropivacaine and Bupivacaine using ultrasound-guided TAP block. After approval from our Institutional Ethical Committee, 100 ASA I and II patients were recruited. Patients of either sex in age group of 18–65 years, undergoing elective lower abdominal surgeries were included in this prospective double-blind study. Patients were randomized into two groups, A and B. Group A (n=50) patients received ultrasound-guided TAP block with 20 ml 0.5% Ropivacaine and those in group B (n =50) received 20 ml 0.25% Bupivacaine at the end of surgery. The postoperative pain score (Numeric Rating Scale, NRS), patient satisfaction score, total requirement of analgesics in the first 24 hours, and the side effects were observed. Statistical tests were conducted using student's t-test, chi-square test, or fisher's exact test whichever was applicable. P < 0.05 was considered statistically significant. Statistically significant difference in the pain scores were observed between the two groups at different time intervals. The mean NRS score was higher for group B at 2, 4, 6 and 14 hour following the block. The duration of analgesia was longer and the total requirement of analgesic was lesser in group A as compared to group B.(p<0.001)Ultrasound-guided TAP block with 0.5% Ropivacaine provides effective analgesia for longer duration and decreases the total analgesic consumption as compared to 0.25% Bupivacaine in lower abdominal surgeries.

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Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis

Cited by 40 publications

References 65 publications

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

Comparison of ropivacaine and bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing elective lower abdominal surgeries - A randomized double-blind trial

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