Department of Oesophagogastric Surgery, Churchill Hospital, Oxford, UK.
Surgeon. 2012 Dec;10(6):361-7. doi: 10.1016/j.surge.2012.07.005. Epub 2012 Sep 10.
Effective post-operative pain management can positively influence patient outcome. Multimodal analgesic regimes are often limited by side-effects. Epidural analgesia may be resource-consuming, restrict mobility and have negative cardiovascular and gastrointestinal consequences. Consequently, there is a need for regional anaesthetic techniques to minimise opioid use, and provide alternatives to epidurals, especially within the context of minimally invasive abdominal surgery and enhanced recovery programmes. This review aims to evaluate the evidence base underlying Transversus abdominis plane (TAP) blockade.
A literature search was performed using the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) using the parameters 'transversus abdominis plane' and 'TAP'. The references within were then searched for applicable studies. Case reports and correspondence were excluded.
Thirteen studies assessed technique and mechanisms of action. Fourteen clinical studies involved a total of 1250 patients. Seven studies (6 Randomised Controlled Trials, RCTs) demonstrated reductions in post-operative morphine requirements (33.3%-73.1%). Five RCTs demonstrated concomitant improvements in pain scores. Five RCTs demonstrated reduced opioid side effects. The one study assessing functional outcome (a Prospective Controlled Trial, PCT) demonstrated earlier return of gastrointestinal function and hospital discharge.
The limited evidence to date suggests that TAP blockade is an effective adjunct to multimodal post-operative analgesia following a range of abdominal surgical procedures. Whether TAP blocks are a viable alternative to epidural analgesia remains to be determined. However, it is likely that as this technique grows in popularity its role, particularly that in enhanced recovery programmes, will be better delineated and refined.
有效的术后疼痛管理可以积极影响患者的预后。多模式镇痛方案通常受到副作用的限制。硬膜外镇痛可能会消耗资源，限制活动能力，并产生负面的心血管和胃肠道后果。因此，需要区域性麻醉技术来最小化阿片类药物的使用，并提供硬膜外镇痛的替代方案，特别是在微创腹部手术和强化康复方案的背景下。本综述旨在评估腹横肌平面（TAP）阻滞的证据基础。
使用 PubMed 数据库（http://www.ncbi.nlm.nih.gov/pubmed/）使用“transversus abdominis plane”和“TAP”参数进行文献检索。然后在参考文献中搜索适用的研究。排除病例报告和通信。
13 项研究评估了技术和作用机制。14 项临床研究共涉及 1250 名患者。7 项研究（6 项随机对照试验，RCT）表明术后吗啡需求减少（33.3%-73.1%）。5 项 RCT 表明疼痛评分同时改善。5 项 RCT 表明阿片类药物副作用减少。评估功能结果的一项研究（一项前瞻性对照试验，PCT）表明胃肠功能更早恢复和更早出院。
迄今为止的有限证据表明，TAP 阻滞是多种腹部手术术后多模式镇痛的有效辅助手段。TAP 阻滞是否是硬膜外镇痛的可行替代方案仍有待确定。然而，随着这项技术的普及，它的作用，特别是在强化康复方案中的作用，很可能会得到更好的描绘和完善。
