Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Postoperative pain management is of great importance in perioperative anesthetic care. Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain and morphine consumption after open lower abdominal operations. Meanwhile, local anesthetic infiltration (LAI) is also commonly used as a traditional method. However, the effectiveness of these two methods has not been compared before. Methods: A meta-analysis of all relevant randomized controlled trials (RCTs) was conducted to compare the efficacy of single shot TAP block with that of single shot LAI for postoperative analgesia in adults. Major medical databases and trial registries were searched for published and unpublished RCTs. The endpoints include postoperative visual analog scale (VAS) pain score, morphine requirement, and rate of postoperative nausea and vomiting (PONV). For continuous data, weighted mean differences (WMDs) were formulated; for dichotomous data, risk ratios (RR) were calculated. Results were derived using a random-/fixed-effects model with 95% confidence interval (CI).

Analgesic Benefits of Ultrasound-Guided Thoraco-Abdominal Wall Peripheral Nerve Blocks

“…The data showed lower pain scores 24 hours postoperatively in the TAP block patients, but no difference in 24-hour morphine requirements or pain scores at 2 and 4 hours after surgery. In this study, TAP block does show a longer duration when compared to infiltration [40].…”

“…A systematic review by Yu [40] compared TAP block to local anesthetic wound infiltration. The surgical procedures were varied but were all non-laparoscopic abdominal surgery [41 -44].…”

To Compare the Postoperative Analgesic Efficacy of Levobupivacaine and Ropivacaine Using Transversus Abdominis Plane Block in Patients Undergoing Inguinal Hernia Surgeries

“…The results are in accordance with other studies. 21,[27][28][29][30] The present study has certain limitations. The pain scores at movement have not been taken into account.…”

The novel use of different bupivacaine preparations with combined regional techniques for postoperative pain management in non–opioid-based laparoscopic inguinal herniorrhaphy

“…4 Preliminary results from one of our current studies examining postoperative analgesia in laparoscopic TEP inguinal herniorrhaphy suggests that TAP blocks and preperitoneal instillation of local anesthetics provide comparable postoperative analgesia. Since it has been reported that TAP blocks provide a better long-lasting effect in lower abdominal surgeries compared to LAI, 5 we decided to use a liposomal bupivacaine (LB) preparation in the TAP blocks.…”