Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University Denis Diderot (Paris VII), Clichy, France.
Colorectal Dis. 2018 Apr;20(4):279-287. doi: 10.1111/codi.14037.
AIM: Transversus abdominis plane (TAP) block is a locoregional anaesthesia technique of growing interest in abdominal surgery. However, its efficacy following laparoscopic colorectal surgery is still debated. This meta-analysis aimed to assess the efficacy of TAP block after laparoscopic colorectal surgery. METHOD: All comparative studies focusing on TAP block after laparoscopic colorectal surgery have been systematically identified through the MEDLINE database, reviewed and included. Meta-analysis was performed according to the Mantel-Haenszel method for random effects. End-points included postoperative opioid consumption, morbidity, time to first bowel movement and length of hospital stay. RESULTS: A total of 13 studies, including 7 randomized controlled trials, were included, comprising a total of 600 patients who underwent laparoscopic colorectal surgery with TAP block, compared with 762 patients without TAP block. Meta-analysis of these studies showed that TAP block was associated with a significantly reduced postoperative opioid consumption on the first day after surgery [weighted mean difference (WMD) -14.54 (-25.14; -3.94); P = 0.007] and a significantly shorter time to first bowel movement [WMD -0.53 (-0.61; -0.44); P < 0.001] but failed to show any impact on length of hospital stay [WMD -0.32 (-0.83; 0.20); P = 0.23] although no study considered length of stay as its primary outcome. Finally, TAP block was not associated with a significant increase in the postoperative overall complication rate [OR = 0.84 (0.62-1.14); P = 0.27]. CONCLUSION: Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative opioid consumption and recovery of postoperative digestive function without any significant drawback.
目的:腹横肌平面(TAP)阻滞是一种局部区域麻醉技术,在腹部手术中越来越受到关注。然而,其在腹腔镜结直肠手术后的效果仍存在争议。本荟萃分析旨在评估腹腔镜结直肠手术后 TAP 阻滞的效果。
方法:通过 MEDLINE 数据库系统地检索并评估了所有关于腹腔镜结直肠手术后 TAP 阻滞的对照研究。采用 Mantel-Haenszel 方法进行随机效应荟萃分析。终点包括术后阿片类药物消耗、发病率、首次肠蠕动时间和住院时间。
结果:共纳入 13 项研究,包括 7 项随机对照试验,共纳入 600 例接受腹腔镜结直肠手术并接受 TAP 阻滞的患者,与 762 例未接受 TAP 阻滞的患者进行比较。这些研究的荟萃分析显示,TAP 阻滞与术后第一天阿片类药物消耗显著减少相关[加权均数差(WMD)-14.54(-25.14;-3.94);P=0.007],首次肠蠕动时间显著缩短[WMD -0.53(-0.61;-0.44);P<0.001],但对住院时间无影响[WMD -0.32(-0.83;0.20);P=0.23],尽管没有研究将住院时间作为主要结局。最后,TAP 阻滞与术后总体并发症发生率的增加无关[OR=0.84(0.62-1.14);P=0.27]。
结论:腹腔镜结直肠手术中 TAP 阻滞可减少术后阿片类药物消耗和促进术后消化功能恢复,且无明显不利影响。
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