Efficacy of the Block in the Transverse Abdominal Plane in Laparoscopic and Robot-assisted Hysterectomy. Systematic Review and Meta - Analysis

Abstract

Study Objective Effectiveness of TAP block both in pain reduction and opioid requirements in post-operative period and to identify the frequency of the associated effects in the use of opiates in patients who underwent laparoscopic or robotic hysterectomy Design Systematic review with meta-analysis of randomized controlled clinical trials. the manual for systematic reviews of Cochrane was followed. Protocol was registered in PROSPERO CRD42018103573. Setting N/A Patients or Participants The search strategy identified 221 relevant bibliographical references: 43 Pubmed, 106 Embase, 67 Cochrane Library, 1 LILACS, 4 Gray. 7 were to perform a quantitative analysis, 227 patients with TAP block with 262 patients blockade with placebo or did not undergo intervention. Interventions Eligibility criteria: Controlled clinical trials, TAP blockade was compared to placebo or no treatment patients who underwent laparoscopic or robot-assisted hysterectomy, benign or malignant pathology and evaluated as outcomes, postoperative pain and opioid requirements, without language restriction, until July 31, 2018 Measurements and Main Results The weighted least squares meta-analysis model was used. Immediate post-surgical pain 7 studies, 518 patients showed a difference in means (DM): - 1.17 (95% CI -1.87;, 46) I2 = 68%, which was statistically significant in favor of the TAP block, is considered minimal and without clinical relevance. Late Pain 7 studies, 518 patients: DM 0.001 (95% CI -0.43;, 44) I2 = 69%; Opioides requirement 6 studies, 447 patients: DM 0.36 (95% CI -0.94, 1.68) I2 = 80% and incidence of nausea and vomiting with a difference of 95% CI = -0.11 (-0.215; -0.006) in favor of the TAP. Conclusion The TAP block slightly decreases early postoperative pain without being maintained over time and does not modify the opioid requirement