The analgesic efficacy of transverse abdominis plane block versus epidural analgesia

Abstract

Background:The aim of the study was to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block. TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed.Methods:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Only trials comparing TAP block with epidural analgesia were included. The primary outcome was pain score at rest (analog scale, 0–10) on postoperative day 1 analyzed in subgroups according to the population (children and adults). Secondary outcomes included rate of hypotension, length of stay, and functional outcomes (time to first bowel sound, time to first flatus).Results:Ten controlled trials, including 505 patients (195 children and 310 adults), were identified. Pain scores at rest on postoperative day 1 were equivalent for TAP block and epidural analgesia groups in children (mean difference: 0.3; 95% confidence interval [CI]: −0.1 to 0.6; I2 = 0%; P = .15) and in adults (mean difference: 0.5; 95% CI: −0.1 to 1.0; I2 = 81%; P = .10). The quality of evidence for our primary outcome was moderate according to the GRADE system. The epidural analgesia group experienced a higher rate of hypotension (relative risk: 0.13; 95% CI: 0.04–0.38; I2 = 0%; P = .0002), while hospital length of stay was shorter in the TAP block group (mean difference: −0.6 days; 95% CI: −0.9 to −0.3 days; I2 = 0%; P < .0001), without impact on functional outcomes.Conclusion:There is moderate evidence that TAP block and epidural analgesia are equally effective in treating postoperative pain in both pediatric and adult patients, while TAP block is associated with fewer episodes of hypotension and reduced length of stay.

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

“…It is proposed that the range of TAP injections be classified as follows [16]: upper subcostal TAP (deep to the rectus, mainly covering T7 and T8), lower subcostal TAP (lateral to rectus, mainly covering T11), lateral TAP (midway between the costal margin and iliac crest in the mid-clavicular line, mainly covering T11 and T12), ilio-inguinal TAP (near the iliac crest lateral to the anterior superior iliac spine, mainly covering T12 and L1), and posterior TAP (in the triangle of Petit). A previous meta-analysis comparing TAP block with EA suggested that TAP block can provide equivalent analgesic effect at rest 24 h after abdominal surgery [28]. However, studies have shown that the analgesic effect of a single TAP block lasts less than 24 h [29,30].…”

Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in transverse abdominis plane block for lower abdominal surgeries: a prospective, randomized, double-blinded study

“…As compared to the traditional epidural analgesia and parenteral analgesics, the TAP block offers innumerable advantages such as decreased hemodynamic perturbations, decreased respiratory depression, nausea, vomiting, decreased cost, and overall patient satisfaction. [ 20 ]…”

Anesthetic considerations for urologic surgeries

“…They block sensory pathways of intercostal nerves T7-T11, subcostal nerve T12, and ilioinguinal and iliohypogastric nerves L1, which are innervated to the anterolateral abdominal wall. Baeriswyl et al [80] conducted a meta-analysis to compare the analgesic efficacy of TAP block and epidural analgesia. There was no significant difference in pain score at postoperative day 1 between the two groups, whereas the incidence rate of hypotension was significantly lower and LOS was shorter in the TAP block group compared to those in the epidural analgesia group.…”