The online version of this article (doi:10.1186/1471-2253-14-121) contains supplementary material, which is available to authorized users.
Nanze Yu, Xiao Long contributed equally to this work.
The authors declare that they have no competing interests. The authors have no support or funding to report.
NY: Conception and design, collection and assembly of data, data analysis and interpretation, manuscript writing; XL: Conception and design, collection and assembly of data, data analysis and interpretation, manuscript writing; JRL-H: Data analysis and interpretation, manuscript writing; JS: Data analysis and interpretation, manuscript writing; XX: Conception and design, manuscript writing; XW: Conception and design, data analysis and interpretation, manuscript writing, final approval of manuscript. All authors read and approved the final manuscript.
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.
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 Major medical databases and trial registries were searched for published and unpublished RCTs.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).
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.
TAP block and LAI provide comparable short-term postoperative analgesia, but TAP block has better long-lasting effect.
Additional file 1: Figure S1: Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies. Figure S2. Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. Figure S3. Funnel plot of VAS score in 2 hours at rest between TAP and LAI groups. Figure S4. Funnel plot of VAS score in 2 hours on movement between TAP and LAI groups. Figure S5. Funnel plot of VAS score in 4 hours at rest between TAP and LAI groups. Figure S6. Funnel plot of VAS score in 4 hours on movement between TAP and LAI groups. Figure S7. Funnel plot of VAS score in 24 hours at rest between TAP and LAI groups. Figure S8. Funnel plot of VAS score in 24 hours on movement between TAP and LAI groups. Figure S9. Funnel plot of mean morphine requirements (mg) 24 hours following surgery between TAP block and local infiltration. Figure S10. Funnel plot of postoperative nausea and vomiting (PONV) rate 24 hours following surgery between TAP block and local infiltration. (DOCX 350 KB)
Schug SA: 2011–the global year against acute pain. Anaesth Intensive Care. 2011, 39 (1): 11-14. PubMed
Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F: Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011, 106 (3): 380-386. 10.1093/bja/aeq363. CrossRefPubMed
Albrecht E, Kirkham KR, Endersby RV, Chan VW, Jackson T, Okrainec A, Penner T, Jin R, Brull R: Ultrasound-guided Transversus Abdominis Plane (TAP) block for laparoscopic gastric-bypass surgery:a prospective randomized controlled double-blinded trial. Obes Surg. 2013, 23 (8): 1309-1314. 10.1007/s11695-013-0958-3. CrossRefPubMed
Petersen PL, Mathiesen O, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB: The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013, 30 (7): 415-421. 10.1097/EJA.0b013e32835fc86f. CrossRefPubMed
Atim A, Bilgin F, Kilickaya O, Purtuloglu T, Alanbay I, Orhan ME, Kurt E: The efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing hysterectomy. Anaesth Intensive Care. 2011, 39 (4): 630-634. PubMed
Sivapurapu V, Vasudevan A, Gupta S, Badhe AS: Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. J Anaesthesiol Clin Pharmacol. 2013, 29 (1): 71-75. 10.4103/0970-9185.105807. CrossRefPubMedPubMedCentral
Coughlin SM, Karanicolas PJ, Emmerton-Coughlin HM, Kanbur B, Kanbur S, Colquhoun PH: Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis. Surg Endosc. 2010, 24 (12): 3167-3176. 10.1007/s00464-010-1111-1. CrossRefPubMed
Ventham NT, Hughes M, O’Neill S, Johns N, Brady RR, Wigmore SJ: Systematic review and meta-analysis of continuous local anaesthetic wound infiltration versus epidural analgesia for postoperative pain following abdominal surgery. Br J Anaesth. 2013, 100 (10): 1280-1289.
Fowler SJ, Christelis N: High volume local infiltration analgesia compared to peripheral nerve block for hip and knee arthroplasty-what is the evidence?. Anaesth Intensive Care. 2013, 41 (4): 458-462. PubMed
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, Kapral S, Marhofer P: Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009, 102 (6): 763-767. 10.1093/bja/aep067. CrossRefPubMed
Petersen PL, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB, Mathiesen O: The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg. 2012, 115 (3): 527-533. PubMed
Salman AE, Yetisir F, Yurekli B, Aksoy M, Yildirim M, Kilic M: The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study. Local Reg Anesth. 2013, 6: 1-7. PubMedPubMedCentral
Myles PS, Urquhart N: The linearity of the visual analogue scale in patients with severe acute pain. Anaesth Intensive Care. 2005, 33 (1): 54-58. PubMed
Ayman M, Materazzi G, Bericotti M, Rago R, Nidal Y, Miccoli P: Bupivacaine 0.5% versus ropivacaine 0.75% wound infiltration to decrease postoperative pain in total thyroidectomy, a prospective controlled study. Minerva Chir. 2012, 67 (6): 511-516. PubMed
Ortiz J, Suliburk JW, Wu K, Bailard NS, Mason C, Minard CG, Palvadi RR: Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med. 2012, 37 (2): 188-192. 10.1097/AAP.0b013e318244851b. CrossRefPubMed
Jorgensen H, Wetterslev J, Moiniche S, Dahl JB: Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000, CD001893-4
- Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials
Jorge R Lujan-Hernandez
- BioMed Central
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