Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Apr-Jun;24(2):e2020.00018.
doi: 10.4293/JSLS.2020.00018.

Transversus Abdominis Plane Block for Laparoscopic Hysterectomy Pain: A Meta-Analysis

Ja Hyun Shin  1 , Ethan M Balk  2 , Karina Gritsenko  3 , Alexander Wang  4 , Kari Plewniak  5 , Naum Shaparin  6
Affiliations
Meta-Analysis

Transversus Abdominis Plane Block for Laparoscopic Hysterectomy Pain: A Meta-Analysis

Ja Hyun Shin et al. JSLS. 2020 Apr-Jun.

Abstract

Objective: Review the analgesic effect of the transversus abdominis plane (TAP) block and its impact on postoperative pain scores and opioid usage for patients undergoing laparoscopic and robotic hysterectomies.

Methods: Systematic review with meta-analysis of randomized controlled trials that compared the effect of TAP block to either placebo or no block on narcotic use (in morphine equivalent units [MEq]) and pain (per visual analog scale) within 24] h after a laparoscopic or robotic hysterectomy for benign or malignant indications. Searches were conducted in PubMed and Embase through May 31, 2019.

Results: Nine randomized controlled trials met eligibility criteria; 7 evaluated laparoscopic hysterectomy and 2 robotic hysterectomy. A total of 688 subjects were included (559 laparoscopic hysterectomy, 129 robotic hysterectomy). Opioid consumption was similar in the first 24] h postoperative with or without TAP block (-0.8 MEq; 95% CI, -2.9, 1.3; 8 TAP arms; N] = 395). Pain scores (visual analog scale) were also similar with or without TAP block (-0.01 U; 95% CI, -0.34, 0.32; 10 TAP arms; N] = 636). Neither meta-analysis showed statistical heterogeneity across studies.

Conclusions: The evidence does not support a benefit of TAP block to reduce pain or opioid use for patients receiving laparoscopic or robotic hysterectomies.

Keywords: Hysterectomy; Laparoscopic; Robotic; TAP block, pain.

PubMed Disclaimer

Conflict of interest statement

Disclosure of Conflicts of Interest and Sources of Financial Support: JS, none; EMB, none; KG, Consultant for Avanos; AW, none; KP, none; NS, Advisory Board & Consultant for Averitas Pharma & AcelRx Pharmaceuticals, Research Grants/Clinical Trials from Grunenthal & Heron Therapeutics.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. Abbreviations: LH, laparoscopic hysterectomy; RA, robotic assisted.
Figure 2.
Figure 2.
Morphine equivalents at 24] h postoperative. Forest plot of studies comparing TAP block versus no block on mean opioid use at 24] h, in mean morphine equivalents. Abbreviations: Bup, bupivacaine; CI, confidence interval; Epi, epinephrine; Levobup, levobupivacaine; MEq, morphine equivalents; Rop, ropivacaine; TAP, transversus abdominis plane. *, Three-arm study with two TAP block arms. For the purpose of meta-analysis, each analysis includes half the 23 participants who received placebo block.
Figure 3.
Figure 3.
VAS pain scores at 24] h postoperative. Forest plot of studies comparing TAP block versus no block on mean pain score at 24] h, on a 10-point VAS. Abbreviations: Bup, bupivacaine; CI, confidence interval; Epi, epinephrine; LSC, laparoscopic guided; Rop, ropivacaine; TAP, transversus abdominis plane; US, ultrasound guided; VAS, visual analog scale. *, Three-arm study with two TAP block arms (0.25% and 0.5%). For the purpose of meta-analysis, each analysis includes half the 23 participants who received placebo block. †, Each woman served as her own control. Patients received TAP on one randomly determined side and placebo block on the other.
See this image and copyright information in PMC

References

    1. Nieboer TE, Hendriks JC, Bongers MY, Vierhout ME, Kluivers KB. Quality of life after laparoscopic and abdominal hysterectomy: A randomized controlled trial. Obstet Gynecol. 2012;119:85–91. - PubMed
    1. Garry R, Fountain J, Mason S, et al. The eVALuate study: Two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004;328:129. - PMC - PubMed
    1. Gendy R, Walsh CA, Walsh SR, Karantanis E. Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: A metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2011;204:388.e381–e388. - PubMed
    1. Korsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. Int J Gynaecol Obstet. 2017;136:128–137. - PubMed
    1. Penner KR, Fleming ND, Barlavi L, Axtell AE, Lentz SE. Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies. Am J Obstet Gynecol. 2015;212:186.e181–e188. - PubMed

Substances