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Meta-Analysis
. 2020 Feb 28;20(1):52.
doi: 10.1186/s12871-020-00969-0.

The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

Chaosheng Qin  1 , Yuanming Liu  2 , Jijun Xiong  1 , Xiaogang Wang  1 , Qinghua Dong  1 , Tingshi Su  3 , Jingchen Liu  4
Affiliations
Meta-Analysis

The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

Chaosheng Qin et al. BMC Anesthesiol. .

Abstract

Background: This review and meta-analysis aims to evaluate the analgesic efficacy of continuous transversus abdominis plane (TAP) block compared with epidural analgesia (EA) in adults after abdominal surgery.

Methods: The databases PubMed, Embase and Cochrane Central Register were searched from inception to June 2019 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy of continuous TAP block compared with EA after abdominal surgery. The weighted mean differences (WMDs) were estimates for continuous variables with a 95% confidence interval (CI) and risk ratio (RR) for dichotomous data. The pre-specified primary outcome was the dynamic pain scores 24 h postoperatively.

Results: Eight trials including 453 patients (TAP block:224 patients; EA: 229 patients) ultimately met the inclusion criteria and seven trials were included in the meta-analysis. Dynamic pain scores after 24 h were equivalent between TAP block and EA groups (WMD:0.44; 95% CI: 0.1 to 0.99; I2 = 91%; p = 0.11). The analysis showed a significant difference between the subgroups according to regularly administering (4 trials; WMD:-0.11; 95% CI: - 0.32 to 0.09; I2 = 0%; p = 0.28) non-steroidal anti-inflammatory drugs (NSAIDs) or not (3 trials; WMD:1.02; 95% CI: 0.09 to 1.96; I2 = 94%; p = 0.03) for adjuvant analgesics postoperatively. The measured time of the urinary catheter removal in the TAP group was significantly shorter (3 trials, WMD:-18.95, 95% CI:-25.22 to - 12.71; I2 = 0%; p < 0.01), as was time to first ambulation postoperatively (4 trials, WMD:-6.61, 95% CI: - 13.03 to - 0.19; I2 = 67%; p < 0.05).

Conclusion: Continuous TAP block, combined with NSAIDs, can provide non-inferior dynamic analgesia efficacy compared with EA in postoperative pain management after abdominal surgery. In addition, continuous TAP block is associated with fewer postoperative side effects.

Keywords: Abdominal surgery; Epidural analgesia; Meta-analysis; TAP block.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing results of search and reasons for exclusion of studies
Fig. 2
Fig. 2
Cochrane collaboration risk of bias summary: evaluation of bias risk items for each included study. Green circle = low risk of bias; red circle = highrisk of bias; yellow circle = unclear risk of bias
Fig. 3
Fig. 3
pain scores at dynamic at 24 h postoperatively according to type of operation (open surgery VS laparoscopic surgery)
Fig. 4
Fig. 4
pain scores at dynamic at 24 h postoperatively according to the way of local anesthetic administration (sustaining administration VS intermittent administration)
Fig. 5
Fig. 5
pain scores at dynamic at 24 h postoperatively according to the using regularly non-steroidal drugs postoperatively (giving regularly the non-steroidal adjuvant analgesics VS not giving)
Fig. 6
Fig. 6
Opioid consumption in 48 h postoperatively according to type of operation (open surgery VS laparoscopic surgery)
See this image and copyright information in PMC

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