P.147: The effect of transversus abdominis plane block for analgesia in patients undergoing liver transplantation: A systematic review and meta-analysis.

Abstract

Background: Adequate analgesia for patients undergoing liver transplant (LT) surgeries is a major challenge for the transplant teams. We undertook this meta-analysis to consolidate the available evidence and to quantify the analgesic potential/opioid sparing capability of TAP block in patients undergoing liver transplant surgeries. Methods: We used a population, intervention, control, and outcome study (PICOS) format for the identification of the potential trials that could be included in the present meta-analysis. The studies evaluating the comparative 24-h morphine consumption during postoperative period in patients undergoing liver transplant surgery (donors) were included as the primary outcome in the analysis. Search strategy: The preliminary data search was performed by two independent researchers in Cochrane Central Register of Controlled Trials and PubMed. Comparative trials published until April, 2018 were included in the analysis. Results: There were a total of 627 articles regarding TAP Block in PubMed and 405 in Cochrane database of which a total of 6 articles were about comparative assessment in liver transplant patients. 2 articles were in duplicate thus giving 4 eligible articles whose full texts were read for inclusion in systematic review. Pooled effect size by random effects model showed that TAP group had 27.59 mg (95% CI: 33.47 – 21.70) lower requirement of morphine at 24 hours for pain mitigation. It also showed that TAP group had less PONV. Conclusions: TAP-block significantly lowers the cumulative postoperative 24-h opioid consumption and PONV in LT donors and recipients. The technique of the block needs standardization for patients undergoing LT surgeries.