From the Department of Anaesthesia, Valais Hospital, Sion (SG), University of Lausanne, Lausanne, Switzerland (SG, EA), Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (KRK) and Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland (EA).
Eur J Anaesthesiol. 2022 Jul 1;39(7):611-618. doi: 10.1097/EJA.0000000000001668. Epub 2022 Feb 7.
Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair.
To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair.
Systematic review and meta-analysis with trial sequential analysis.
MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020.
We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic.
Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of -0.8 (-1.3 to -0.2); I2 = 85%; P = 0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate.
There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair.
PROSPERO CRD42020208053.
腹横肌平面（TAP）阻滞和局部麻醉浸润均已用于缓解腹股沟或脐下疝修补术后的疼痛。
确定 TAP 阻滞或局部麻醉浸润是否是腹股沟或脐下疝修补术后最佳的镇痛选择。
系统评价和荟萃分析，同时进行试验序贯分析。
MEDLINE、Embase、Cochrane 对照临床试验中心注册库、Web of Science，检索截至 2020 年 6 月。
我们检索了比较腹股沟或脐下疝修补术后 TAP 阻滞与伤口浸润的随机对照试验。主要结局为术后 2 小时静息疼痛评分（模拟量表 0 至 10）。次要疼痛相关结局包括术后 12 小时和 24 小时静息疼痛评分，以及术后 2、12 和 24 小时静脉吗啡消耗量。其他寻求的次要结局包括与阻滞相关的并发症，如术后感染、血肿、内脏损伤和局部麻醉全身毒性的发生率。
共确定了 7 项试验，包括 420 名患者。与伤口浸润相比，TAP 阻滞在术后 2 小时的静息疼痛评分有显著差异，平均差值（95%置信区间）为 -0.8（-1.3 至 -0.2）；I2=85%；P=0.01。大多数次要疼痛相关结局也显著改善。没有并发症报告。总体证据质量为中等。
有中等质量证据表明，与腹股沟或脐下疝修补术后伤口浸润相比，TAP 阻滞提供了更好的镇痛效果。
PROSPERO CRD42020208053。
