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

Nanze Yu, Xiao Long, Jorge R Lujan-Hernandez, Julien Succar, Xin Xin, Xiaojun Wang, Nanze Yu, Xiao Long, Jorge R Lujan-Hernandez, Julien Succar, Xin Xin, Xiaojun Wang

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 Major medical databases and trial registries were searched for published and unpublished RCTs.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

Keywords: Local anesthetic infiltration; Meta-analysis; Postoperative analgesia; Transversus abdominis plane block.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Random-effects meta-analysis of mean VAS pain score at rest 2 h following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 3
Figure 3
Random-effects meta-analysis of mean VAS pain score with movement 2 hours following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 4
Figure 4
Random-effects meta-analysis of mean VAS pain score at rest 4 hours following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 5
Figure 5
Random-effects meta-analysis of mean VAS pain score with movement 4 hours following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 6
Figure 6
Random-effects meta-analysis of mean VAS pain score at rest 24 h following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 7
Figure 7
Fixed-effects meta-analysis of mean VAS pain score on movement 24 h following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 8
Figure 8
Random-effects meta-analysis of mean morphine requirement (mg) 24 h following surgery with TAP block and LAI. LAI, local anesthetic infiltration; TAP, transversus abdominis plane; VAS, visual analog scale.
Figure 9
Figure 9
Fixed-effects meta-analysis of rate of PONV 24 h following surgery with TAP block and LAI. LAI, local anesthetic infiltration; PONV, postoperative nausea and vomiting; TAP: transversus abdominis plane.

References

    1. Schug SA. 2011–the global year against acute pain. Anaesth Intensive Care. 2011;39(1):11–14.
    1. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007;104(3):689–702. doi: 10.1213/01.ane.0000255040.71600.41.
    1. Mhuircheartaigh RJ, Moore RA, McQuay HJ. Analysis of individual patient data from clinical trials: epidural morphine for postoperative pain. Br J Anaesth. 2009;103(6):874–881. doi: 10.1093/bja/aep300.
    1. Kuppuvelumani P, Jaradi H, Delilkan A. Abdominal nerve blockade for postoperative analgesia after caesarean section. Asia Oceania J Obstet Gynaecol. 1993;19(2):165–169. doi: 10.1111/j.1447-0756.1993.tb00368.x.
    1. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–1026. doi: 10.1046/j.1365-2044.2001.02279-40.x.
    1. 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. doi: 10.1093/bja/aeq363.
    1. 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. doi: 10.1007/s11695-013-0958-3.
    1. 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. doi: 10.1097/EJA.0b013e32835fc86f.
    1. 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.
    1. 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. doi: 10.4103/0970-9185.105807.
    1. Belavy D, Cowlishaw PJ, Howes M, Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103(5):726–730. doi: 10.1093/bja/aep235.
    1. Skjelsager A, Ruhnau B, Kistorp TK, Kridina I, Hvarness H, Mathiesen O, Dahl JB. Transversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study. Acta Anaesthesiol Scand. 2013;57(4):502–508. doi: 10.1111/aas.12080.
    1. Araco A, Pooney J, Araco F, Gravante G. Transversus abdominis plane block reduces the analgesic requirements after abdominoplasty with flank liposuction. Ann Plast Surg. 2010;65(4):385–388. doi: 10.1097/SAP.0b013e3181cc2a24.
    1. Sforza M, Andjelkov K, Zaccheddu R, Nagi H, Colic M. Transversus abdominis plane block anesthesia in abdominoplasties. Plast Reconstr Surg. 2011;128(2):529–535. doi: 10.1097/PRS.0b013e31821e6f51.
    1. Sahin L, Sahin M, Gul R, Saricicek V, Isikay N. Ultrasound-guided transversus abdominis plane block in children: a randomised comparison with wound infiltration. Eur J Anaesthesiol. 2013;30(7):409–414. doi: 10.1097/EJA.0b013e32835d2fcb.
    1. Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. Br J Anaesth. 2011;106(6):882–886. doi: 10.1093/bja/aer069.
    1. Johns N, O’Neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of Transversus Abdominis Plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis. 2012;14(10):e635–e642. doi: 10.1111/j.1463-1318.2012.03104.x.
    1. 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. doi: 10.1007/s00464-010-1111-1.
    1. Einarsson JI, Sun J, Orav J, Young AE. Local analgesia in laparoscopy: a randomized trial. Obstet Gynecol. 2004;104(6):1335–1339. doi: 10.1097/01.AOG.0000146283.90934.fd.
    1. Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy–a systematic review. Best Pract Res Clin Anaesthesiol. 2005;19(2):275–292. doi: 10.1016/j.bpa.2004.12.007.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. doi: 10.1016/0197-2456(95)00134-4.
    1. Chalmers TC, Smith H, Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981;2(1):31–49. doi: 10.1016/0197-2456(81)90056-8.
    1. 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.
    1. 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.
    1. Gousheh SM, Nesioonpour S, Javaher Foroosh F, Akhondzadeh R, Sahafi SA, Alizadeh Z. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med. 2013;3(1):214–218. doi: 10.5812/aapm.9880.
    1. 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. doi: 10.1093/bja/aep067.
    1. 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.
    1. 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.
    1. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth. 2012;109(5):679–687. doi: 10.1093/bja/aes279.
    1. Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011;23(1):7–14. doi: 10.1016/j.jclinane.2010.05.008.
    1. 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.
    1. 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.
    1. 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. doi: 10.1097/AAP.0b013e318244851b.
    1. Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639–643. doi: 10.1067/mem.2001.118012.
    1. 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, (4):CD001893.
    1. Gupta A, Favaios S, Perniola A, Magnuson A, Berggren L. A meta-analysis of the efficacy of wound catheters for post-operative pain management. Acta Anaesthesiol Scand. 2011;55(7):785–796. doi: 10.1111/j.1399-6576.2011.02463.x.
    1. Soltani Mohammadi S, Dabir A, Shoeibi G. Efficacy of transversus abdominis plane block for acute postoperative pain relief in kidney recipients: a double-blinded clinical trial. Pain Med. 2014;15(3):460–464. doi: 10.1111/pme.12311.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe