The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: This review and meta-analysis aims to evaluate the analgesic efficacy of continuous transversus abdominis plane (TAP) block compared with epidural analgesia (EA) in adults after abdominal surgery. Methods: The databases PubMed, Embase and Cochrane Central Register were searched from inception to June 2019 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy of continuous TAP block compared with EA after abdominal surgery. The weighted mean differences (WMDs) were estimates for continuous variables with a 95% confidence interval (CI) and risk ratio (RR) for dichotomous data. The pre-specified primary outcome was the dynamic pain scores 24 h postoperatively. Results: Eight trials including 453 patients (TAP block:224 patients; EA: 229 patients) ultimately met the inclusion criteria and seven trials were included in the meta-analysis. Dynamic pain scores after 24 h were equivalent between TAP block and EA groups (WMD:0.44; 95% CI: 0.1 to 0.99; I 2 = 91%; p = 0.11). The analysis showed a significant difference between the subgroups according to regularly administering (4 trials; WMD:-0.11; 95% CI: − 0.32 to 0.09; I 2 = 0%; p = 0.28) non-steroidal anti-inflammatory drugs (NSAIDs) or not (3 trials; WMD:1.02; 95% CI: 0.09 to 1.96; I 2 = 94%; p = 0.03) for adjuvant analgesics postoperatively. The measured time of the urinary catheter removal in the TAP group was significantly shorter (3 trials, WMD:-18.95, 95% CI:-25.22 to − 12.71; I 2 = 0%; p < 0.01), as was time to first ambulation postoperatively (4 trials, WMD:-6.61, 95% CI: − 13.03 to − 0.19; I 2 = 67%; p < 0.05). Conclusion: Continuous TAP block, combined with NSAIDs, can provide non-inferior dynamic analgesia efficacy compared with EA in postoperative pain management after abdominal surgery. In addition, continuous TAP block is associated with fewer postoperative side effects.

[Retracted] Analysis of Interventional Application Effect of Ultrasound‐Guided QLB and TAPB in the Treatment and Analgesia of Patients Undergoing Laparoscopic Colorectal Surgery

“…Meanwhile, it can inhibit abdominal visceral pain, which is beneficial to relieving stress response and stabilize intraoperative blood pressure and heart rate. TAPB anesthesia guided by ultrasound can improve the stress response and immune function of patients undergoing laparoscopic colon cancer surgery [ 15 , 16 ]. The results of this study are basically consistent with the conclusion.…”

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

“…The inclusion of regional anesthesia in perioperative pain control regimens has been shown to be superior to opioid or non-opioid analgesic modalities alone (4)(5)(6). However, some studies have shown ethnic-based disparities in the use of regional anesthesia (1,(7)(8)(9)(10)(11).…”

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review

“…A number of reviews have been conducted on postoperative pain management, some of which include ultrasound-guided transversus abdominis pain block, with some exploring the best anesthetic technique [ 25 , 26 , 27 , 28 ] and abdominal surgeries [ 3 , 29 , 30 , 31 , 32 , 33 , 34 ]. Other reviews focused on specific conditions, such as colorectal surgery [ 35 , 36 ], wound infiltration [ 33 , 37 ], caesarean delivery [ 38 ], bariatric surgery [ 39 , 40 ], lower abdominal incisions [ 16 ], breast reconstruction [ 41 ], and minimally invasive surgery [ 42 ].…”