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. 2023 Dec 12;23(1):408.
doi: 10.1186/s12871-023-02369-6.

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials

Burhan Dost  1 , Alessandro De Cassai  2 , Eleonora Balzani  3 , Federico Geraldini  2 , Serkan Tulgar  4 , Ali Ahiskalioglu  5   6 , Yunus Emre Karapinar  5   6 , Müzeyyen Beldagli  4 , Paolo Navalesi  7   8 , Cengiz Kaya  9
Affiliations

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials

Burhan Dost et al. BMC Anesthesiol. .

Abstract

Background: Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC.

Methods: A frequentist network meta-analysis of randomized controlled trials (RCTs) was conducted. We systematically searched PubMed (via the National Library of Medicine), EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to March 2023. The study included RCTs that enrolled adult patients (≥ 18 years) who underwent LC and received either pre-operative or postoperative TAP blocks. The primary outcome assessed was 24-hour postoperative morphine consumption (mg). Additionally, pain rest scores within 3 hours, 12 hours, and 24 hours, as well as postoperative nausea and vomiting (PONV), were considered as pre-specified secondary outcomes.

Results: A total of 34 trials with 2317 patients were included in the analysis. Postoperative TAP block demonstrated superiority over the pre-operative TAP block in reducing opioid consumption (MD 2.02, 95% CI 0.87 to 3.18, I2 98.6%, p < 0.001). However, with regards to postoperative pain, neither pre-operative nor postoperative TAP blocks exhibited superiority over each other at any of the assessed time points. The postoperative TAP block consistently ranked as the best intervention using SUCRA analysis. Moreover, the postoperative TAP block led to the most significant reduction in PONV.

Conclusions: The findings suggest that the postoperative TAP block may be slightly more effective in reducing 24-hour postoperative opioid consumption and PONV when compared to the pre-operative TAP block.

Trial registration: PROSPERO, CRD42023396880 .

Keywords: Analgesics; Anesthesia, analgesia; Laparoscopic cholecystectomy; Meta-analysis; Nerve block; Ultrasonography.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. The diagram illustrates the study selection process and provides reasons for excluding records during the screening. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Bias assessment. An overview of the ROB2 (Risk of Bias 2) assessment is presented in this figure
Fig. 3
Fig. 3
Network plot for intravenous morphine equivalents (mg) in the first 24 h. Each technique is represented at each corner of the polygon. The widths of the lines connecting interventions are proportionate to the number of trials assessing the comparisons
Fig. 4
Fig. 4
Forest plots for the pain scores. This figure displays the forest plots for the pain scores, providing a graphical representation of the results from individual studies
See this image and copyright information in PMC

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