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

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Abstract

Background

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. 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.

Methods

A 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 Major medical databases and trial registries were searched for published and unpublished RCTs.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).

Results

Four 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.

Conclusion

TAP block and LAI provide comparable short-term postoperative analgesia, but TAP block has better long-lasting effect.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2253-14-121) contains supplementary material, which is available to authorized users.

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Most cited references 35

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Abdominal field block: a new approach via the lumbar triangle.

A N Rafi (2001)

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Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy.

A.A. El-Dawlatly, A. Turkistani, S.C. Kettner … (2009)

The transversus abdominis plane (TAP) block is usually performed by landmark-based methods. This prospective, randomized, and double-blinded study was designed to describe a method of ultrasound-guided TAP block and to evaluate the intra- and postoperative analgesic efficacy in patients undergoing laparoscopic cholecystectomy under general anaesthesia with or without TAP block. Forty-two patients undergoing laparoscopic cholecystectomy were randomized to receive standard general anaesthetic either with (Group A, n=21) or without TAP block (Group B, n=21). Ultrasound-guided bilateral TAP block was performed with a high frequent linear ultrasound probe and an in-plane needle guidance technique with 15 ml bupivacaine 5 mg ml(-1) on each side. Intraoperative use of sufentanil and postoperative demand of morphine using a patient-controlled analgesia device were recorded. Ultrasonographic visualization of the relevant anatomy, detection of the shaft and tip of the needle, and the spread of local anaesthetic were possible in all cases where a TAP block was performed. Patients in Group A received significantly less [corrected] intraoperative sufentanil and postoperative morphine compared with those in Group B [mean (SD) 8.6 (3.5) vs 23.0 (4.8) microg, P<0.01, and 10.5 (7.7) vs 22.8 (4.3) mg, P<0.05]. Ultrasonographic guidance enables exact placement of the local anaesthetic for TAP blocks. In patients undergoing laparoscopic cholecystectomy under standard general anaesthetic, ultrasound-guided TAP block substantially reduced the perioperative opioid consumption.

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Clinically significant changes in pain along the visual analog scale.

S Bird, Price Dickson (2001)

We sought to test the hypothesis that the change in visual analog scale (VAS) associated with a clinically significant change in pain is related to the initial VAS score. A convenience sample of adults with isolated extremity trauma was enrolled. A VAS score was obtained on entry into the study. Descriptions of change in pain ("lot less," "little less," "about the same," "little more," or "lot more") and VAS scores were then obtained every 30 minutes until the patient was free of pain or discharged or a total of 2 hours had passed. Patients were divided into 3 cohorts on the basis of the initial VAS score: VAS score of less than 34, VAS score of 34 to 66, and VAS score of 67 or greater. The absolute values of VAS changes associated with pain descriptions of a "little less" or "little more" (defined as clinically significant), "about the same" (defined as clinically insignificant), and "lot less" or "lot more" were calculated. The change in VAS associated with clinically significant changes in pain in the cohort with VAS scores of less than 34 was 13+/-14 (mean+/-SD), which was significantly lower than that of the cohort with VAS scores of 67 or greater (28+/-21). There was no statistically significant difference in clinically significant changes in pain between the middle cohort and either the upper or lower cohorts (P =.07 and P =.29, respectively). There was no significant change in VAS for clinically insignificant changes in pain among the 3 cohorts (3+/-4, 6+/-6, and 8+/-16, respectively). Patients with greater pain require a greater change in VAS score to achieve clinically significant pain relief.

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Author and article information

Contributors

Nanze Yu: yunanze@hotmail.com

Xiao Long: pumclongxiao@126.com

Jorge R Lujan-Hernandez: Jorge.lujan87@hotmail.com

Julien Succar: julas19@gmail.com

Xin Xin: xinxin.harvard@gmail.com

Xiaojun Wang: xjwang100@hotmail.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 15 December 2014

Publication date PMC-release: 15 December 2014

Publication date Collection: 2014

Volume: 14

Issue: 1

Electronic Location Identifier: 121

Affiliations

[ ]Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730 China

[ ]Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA

[ ]Department of Surgery, University of Kentucky, Lexington, KY USA

[ ]Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China

Article

Publisher ID: 329

DOI: 10.1186/1471-2253-14-121

PMC ID: 4289539

PubMed ID: 25580086

SO-VID: 802e7ca0-0996-4a1c-a3d6-818214eff4c0

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 March 2014

Date accepted : 11 December 2014

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: transversus abdominis plane block,local anesthetic infiltration,postoperative analgesia,meta-analysis

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: transversus abdominis plane block, local anesthetic infiltration, postoperative analgesia, meta-analysis

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

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Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

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Irish Journal of Paramedicine

Most cited references 35

Abdominal field block: a new approach via the lumbar triangle.

Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy.

Clinically significant changes in pain along the visual analog scale.

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