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

Nanze Yu,Xiaojun Wang,Xiao Long,Xin Xin,Julien Succar,Jorge R Lujan-Hernandez

doi:10.1186/1471-2253-14-121

Abstract

BackgroundPostoperative 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.MethodsA 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 Major medical databases and trial registries were searched for published and unpublished RCTs.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).ResultsFour RCTs, encompassing 96 TAP-block and 100 LAI patients, were included in the final analysis. Patients in the TAP-block group had lower VAS pain scores 24 hours postoperatively compared with the LAI group, both at rest (WMD [95% CI] = -0.67 [p < 0.01] and with movement (WMD = -0.89, p < 0.01). There were no significant between-group differences in 24-hour postoperative morphine requirements, the rates if PONV or VAS pain scores at 2 and 4 h postoperatively.ConclusionTAP block and LAI provide comparable short-term postoperative analgesia, but TAP block has better long-lasting effect.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2253-14-121) contains supplementary material, which is available to authorized users.

Highlights

Postoperative pain management is of great importance in perioperative anesthetic care
Data analyzed in this study demonstrated that Transversus abdominis plane (TAP) block did not significantly reduce morphine requirements or postoperative nausea and vomiting (PONV) compared with local anesthetic infiltration (LAI) 24 h after surgery, suggesting that both methods have good postoperative analgesic effect
TAP block is comparable to LAI for short-term analgesia; it could provide better long-lasting analgesia especially at 24 h after surgery

Summary

Introduction

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. Pain management is an important aspect of perioperative anesthetic care, while whether acute postoperative pain control affects surgical outcomes remains controversial [2]. TAP-block technique has been shown to be a safe and effective postoperative adjunct analgesia method in a variety of general [7,8], gynecological [9,10,11], urological [12], plastic [13,14], and pediatric [15,16] surgeries, and it is suggested as part of the multimodal anesthetic approach to enhance recovery after lower abdominal surgeries [17]. Single shot local anesthetic infiltration (LAI) is a commonly used method for reducing postoperative pain [18,19]. There have been a number of randomized controlled trials (RCTs)

Methods

Results

Discussion

Conclusion