Charlton Shona, Cyna Allan M, Middleton Philippa, Griffiths James D
Department of Women's Anaesthesia, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006.
Cochrane Database Syst Rev. 2010 Dec 8(12):CD007705. doi: 10.1002/14651858.CD007705.pub2.
The transversus abdominis plane (TAP) block is a peripheral nerve block which anaesthetises the abdominal wall. The increasing use of TAP block, as a form of pain relief after abdominal surgery warrants evaluation of its effectiveness as an adjunctive technique to routine care and, when compared with other analgesic techniques.
To assess effects of TAP blocks (and variants) on postoperative analgesia requirements after abdominal surgery.
We searched specialised registers of Cochrane Anaesthesia and Cochrane Pain, Palliative and Supportive Care Review Groups, CENTRAL, MEDLINE, EMBASE and CINAHL to June 2010.
We included randomised controlled trials (RCTs) comparing TAP block or rectus sheath block with: no TAP or rectus sheath block; placebo; systemic, epidural or any other analgesia.
At least two review authors assessed study eligibility and risk of bias, and extracted data.
We included eight studies (358 participants), five assessing TAP blocks, three assessing rectus sheath blocks; with moderate risk of bias overall. All studies had a background of general anaesthesia in both arms in most cases.Compared with no TAP block or saline placebo, TAP block resulted in significantly less postoperative requirement for morphine at 24 hours (mean difference (MD) -21.95 mg, 95% confidence interval (CI) -37.91 to 5.96; five studies, 236 participants) and 48 hours (MD -28.50, 95% CI -38.92 to -18.08; one study of 50 participants) but not at two hours (all random-effects analyses). Pain at rest was significantly reduced in two studies, but not a third.Only one of three included studies of rectus sheath blocks found a reduction in postoperative analgesic requirements in participants receiving blocks. One study, assessing number of participants who were pain-free after their surgery, found more participants who received a rectus sheath block to be pain-free for up to 10 hours postoperatively. As with TAP blocks, rectus sheath blocks made no apparent impact on nausea and vomiting or sedation scores.
AUTHORS' CONCLUSIONS: No studies have compared TAP block with other analgesics such as epidural analgesia or local anaesthetic infiltration into the abdominal wound. There is only limited evidence to suggest use of perioperative TAP block reduces opioid consumption and pain scores after abdominal surgery when compared with no intervention or placebo. There is no apparent reduction in postoperative nausea and vomiting or sedation from the small numbers of studies to date. Many relevant studies are currently underway or awaiting publication.
腹横肌平面（TAP）阻滞是一种可麻醉腹壁的外周神经阻滞。随着TAP阻滞作为腹部手术后一种镇痛方式的使用日益增加，有必要评估其作为常规护理辅助技术的有效性，并与其他镇痛技术进行比较。
评估TAP阻滞（及其变体）对腹部手术后镇痛需求的影响。
我们检索了Cochrane麻醉学专业注册库、Cochrane疼痛、姑息与支持治疗综述组、Cochrane系统评价数据库、医学期刊数据库、荷兰医学文摘数据库和护理学与健康领域数据库，检索截至2010年6月的数据。
我们纳入了随机对照试验（RCT），比较TAP阻滞或腹直肌鞘阻滞与以下情况：不进行TAP或腹直肌鞘阻滞；安慰剂；全身、硬膜外或任何其他镇痛方法。
至少两名综述作者评估了研究的纳入资格和偏倚风险，并提取了数据。
我们纳入了八项研究（358名参与者），五项评估TAP阻滞，三项评估腹直肌鞘阻滞；总体偏倚风险为中度。在大多数情况下，所有研究的两组均以全身麻醉为背景。与不进行TAP阻滞或使用生理盐水安慰剂相比，TAP阻滞在术后24小时（平均差（MD）-21.95mg，95%置信区间（CI）-37.91至5.96；五项研究，236名参与者）和48小时（MD -28.50，95%CI -38.92至-18.08；一项50名参与者的研究）时，术后吗啡需求量显著减少，但在两小时时未减少（所有随机效应分析）。两项研究中静息时疼痛显著减轻，但第三项未减轻。纳入的三项腹直肌鞘阻滞研究中，只有一项发现接受阻滞的参与者术后镇痛需求减少。一项评估术后无疼痛参与者数量的研究发现，接受腹直肌鞘阻滞的参与者术后长达10小时内无疼痛的人数更多。与TAP阻滞一样，腹直肌鞘阻滞对恶心呕吐或镇静评分无明显影响。
尚无研究将TAP阻滞与其他镇痛方法如硬膜外镇痛或腹部伤口局部麻醉浸润进行比较。与不干预或安慰剂相比，仅有有限证据表明围手术期使用TAP阻滞可减少腹部手术后的阿片类药物消耗量和疼痛评分。迄今为止，少量研究并未显示术后恶心呕吐或镇静有明显减轻。目前许多相关研究正在进行中或等待发表。
