Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis.

Elsa Maria Vásquez-Trespalacios,Jerutsa Catalina Orjuela,Claudia Vargas,Marcela Jimenez-Arango,Claudia López-Ruiz,José Fernando De Los Ríos,Diego Fernando Rojas-Gualdrón

doi:10.1055/s-0041-1740595

Elsa Maria Vásquez-Trespalacios, Jerutsa Catalina Orjuela + Show 5 more

Open Access

https://doi.org/10.1055/s-0041-1740595

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Abstract

To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Two researchers independently evaluated the eligibility of the selected articles. Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2 = 68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2 = 69%); opioid requirement: 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 TAP. With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. PROSPERO ID - CRD42018103573.

Highlights

Hysterectomy is a surgical procedure often associated with significant postoperative pain
56 Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain López-Ruiz et al Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that transverse abdominal plane (TAP) block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores
The results obtained in the present meta-analysis indicate that TAP block improves early postoperative pain as indicated by the statistically significant difference; the clinical benefit of this difference is unclear

Summary

Introduction

Hysterectomy is a surgical procedure often associated with significant postoperative pain. This could be attributed to injuries suffered in the pelvic plexus,[1] which is predominantly composed of neural structures in the sacral and lower lumbar segments, as well as to inflammation caused by direct trauma to tissues during the surgical procedure.[2] it has been considered that the block in the transverse abdominal plane (TAP), which acts by blocking iliohypogastric, ilioinguinal, and lower thoracic spinal nerves, could be useful. The pain referred by patients after a hysterectomy is more of a visceral origin. The use of analgesic medications, including opioids, which are associated with minor side effects (pruritus, nausea, and vomiting), as well as major side effects (respiratory depression and addiction),[5] are sometimes required, increasing postoperative morbidity and mortality.[6,7]

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