Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Tech Coloproctol. 2020 Aug;24(8):787-802. doi: 10.1007/s10151-020-02206-9. Epub 2020 Apr 6.
BACKGROUND: Multimodal opioid-sparing analgesia is a key component of the enhanced recovery after surgery (ERAS) protocol for postoperative pain management. Transversus abdominis plane (TAP) block has contributed to the implementation of this approach in different kinds of surgical procedures. The aim of this study was to evaluate the efficacy of TAP block and its impact on recovery in colorectal surgery. METHODS: A comprehensive literature search of the PubMed, Embase, and Scopus databases was conducted. Studies that compared TAP block to a control group (no TAP block or placebo) after colorectal resections were included. The effects of TAP block in patients undergoing colorectal surgery were assessed, including the technical aspects of the procedure. Two measures were used to evaluate the effectiveness of postoperative pain control: a numeric pain rating score at rest and on coughing or movement at 24 h following surgery and the opioid requirement at 24 h. Clinical aspects of recovery were postoperative ileus, surgical site infection, postoperative nausea and vomiting, and length of hospital stay. RESULTS: Sixteen studies were included in the analysis. Data showed that TAP block is a safe procedure associated with a significant reduction in the pain score at rest [WMD - 0.91 (95% CI - 1.56; - 0.27); p < 0.05] and on coughing or movement [WMD - 0.36 (95% CI - 0.72; - 0.01); p < 0.05] at 24 h after surgery and a significant decrease in morphine consumption in the TAP block group the day after surgery [WMD - 2.07 (95% CI - 2.63; - 1.51); p < 0.001]. CONCLUSIONS: TAP block appears to provide both an effective analgesia and a significant reduction in opioid use on the first postoperative day after colorectal surgery. Its use does not seem to lead to increased postoperative complications.
背景:多模式阿片类药物节约性镇痛是术后康复(ERAS)方案中术后疼痛管理的一个关键组成部分。腹横肌平面(TAP)阻滞有助于在不同类型的手术中实施这种方法。本研究旨在评估 TAP 阻滞在结直肠手术后的疗效及其对恢复的影响。
方法:对 PubMed、Embase 和 Scopus 数据库进行了全面的文献检索。纳入了比较 TAP 阻滞与结直肠切除术后对照组(无 TAP 阻滞或安慰剂)的研究。评估了 TAP 阻滞对接受结直肠手术患者的影响,包括该程序的技术方面。使用两种措施评估术后疼痛控制的效果:术后 24 小时静息时和咳嗽或运动时的数字疼痛评分以及术后 24 小时的阿片类药物需求。恢复的临床方面包括术后肠梗阻、手术部位感染、术后恶心和呕吐以及住院时间。
结果:纳入了 16 项研究进行分析。数据显示,TAP 阻滞是一种安全的操作,与静息时疼痛评分显著降低相关[WMD -0.91(95% CI -1.56;-0.27);p<0.05]和咳嗽或运动时疼痛评分显著降低[WMD -0.36(95% CI -0.72;-0.01);p<0.05],术后 24 小时吗啡消耗量也显著降低[WMD -2.07(95% CI -2.63;-1.51);p<0.001]。
结论:TAP 阻滞似乎在结直肠手术后第一天提供了有效的镇痛和显著减少阿片类药物的使用。其使用似乎不会导致术后并发症增加。
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