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26.10.2017 | Review | Ausgabe 2/2018

Surgical Endoscopy 2/2018

Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis

Zeitschrift:
Surgical Endoscopy > Ausgabe 2/2018
Autoren:
Tak Kyu Oh, Se-Jun Lee, Sang-Hwan Do, In-Ae Song
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-017-5871-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery.

Methods

We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0–2 h postoperatively), late pain at movement (NRS score at 24 h postoperatively), late pain at rest (NRS score at 24 h postoperatively), and postoperative opioid consumption (up to 24 h postoperatively). We used a random-effects model for the meta-analysis and Egger’s regression test to detect publication bias.

Results

We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: − 0.695, P < 0.0001 for early pain and − 0.242, P = 0.029 for late pain). There was no significant difference between the TAP block and control groups in early pain at rest (P = 0.475), late pain at rest (P = 0.826), and postoperative opioid consumption (P = 0.257).

Conclusions

The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) periods at rest after laparoscopic surgery.

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Zusatzmaterial
Additional Figure 1 Early pain at rest (NRS score at 0–2 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 364 KB)
464_2017_5871_MOESM1_ESM.tif
Additional Figure 2 Early pain at movement (NRS score at 0–2 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 376 KB)
464_2017_5871_MOESM2_ESM.tif
Additional Figure 3 Late pain at rest (NRS score at 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 544 KB)
464_2017_5871_MOESM3_ESM.tif
Additional Figure 4. Late pain at movement (NRS score at 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 447 KB)
464_2017_5871_MOESM4_ESM.tif
Additional Figure 5. Postoperative opioid consumption (intravenous morphine in mg up to 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). (TIF 339 KB)
464_2017_5871_MOESM5_ESM.tif
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