Le bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées

Abstract

Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. Source We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i.e., placebo, epidural analgesia, intrathecal morphine (ITM), and ilioinguinal nerve block after abdominal surgery]. Meta-analyses were performed on postoperative pain scores at rest at six, 12, and 24 hr (visual analogue scale, 0-10) and on 24-hr opioid consumption. Principal findings In the 51 trials identified, compared with placebo, TAP block reduced the VAS for pain at six hours by 1.4 (95% confidence interval [CI], -1.9 to -0.8; P\0.001), at 12 hr by 2.0 (95% CI, -2.7 to -1.4; P\0.001), and at 24 hr by 1.2 (95% CI, -1.6 to -0.8; P \ 0.001). Similarly, compared with placebo, TAP block reduced morphine consumption at 24 hr after surgery (mean difference, -14.7 mg; 95% CI, -18.4 to -11.0; P \0.001). We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery, appendectomy, inguinal surgery, bariatric surgery, and urological surgery. Nevertheless, separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy. Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption. It may have particular utility when neuraxial techniques or opioids are contraindicated. RésuméObjectif Le bloc dans le plan du muscle transverse de l'abdomen (ou TAP bloc) a été décrit comme une technique efficace de contrô le de la douleur après une chirurgie abdominale. Nous avons réalisé une revue systématique et une méta-analyse des études randomisées contrô lées (ERC) pour faire un état des lieux du nombre croissant d'études

The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery

“…It also enabled ultrasound-guided needle injections and the monitoring of local anaesthetic spread [2]. This method has been described in patients following laparoscopy and laparotomy colorectal procedures, laparoscopy cholecystectomy, appendectomy, abdominoplasty, urological procedures, inguinal hernia repair and gynaecological procedures, such as hysterectomy and caesarean section [3].…”

Pain Management in Weight Loss Surgery: Aiming for Multimodal Approach

“…Designed to provide anesthesia in the anterior abdominal wall (T6-L1) it has demonstrated a reduction in pain scores and opioid consumption in early post operatory for abdominal and gynecological surgery [7].…”

Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults

“…(Reg Anesth Pain Med 2018;43: [5][6][7][8][9][10][11][12][13] P ain following abdominal surgery can adversely affect postoperative recovery, potentially contributing to morbidity and mortality. 1 For larger abdominal operations, epidural analgesia has long been used as a viable method for managing postoperative pain.…”

“…7 A more recent meta-analysis of TAP blocks versus placebo demonstrated a significant reduction in visual analog scale (VAS) pain scores and morphine consumption, 8 but a limiting factor of single-shot TAP blocks is a 24-hour maximum expected duration of action. 5 To prolong the TAP block, catheters are increasingly being inserted and trialed in a range of procedures, which otherwise might commonly favor epidural placement.…”