Viderman Dmitriy, Aubakirova Mina, Abdildin Yerkin G
Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan.
Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan.
Front Med (Lausanne). 2022 Feb 23;8:802039. doi: 10.3389/fmed.2021.802039. eCollection 2021.
Acute postoperative pain is one of the most common concerns during the early postoperative period in colorectal surgery. Opioids still represent the cornerstone of postoperative pain management, yet they often result in significant side effects such as nausea and/or vomiting, sedation, urinary retention, delayed recovery of colonic motility, respiratory depression, and postoperative ileus. Transversus abdominis plane (TAP) block has been widely used for postoperative analgesia in various abdominal surgeries. The primary aim of this meta-analysis was to compare the postoperative opioid requirements of patients in the TAP block group and the control group (placebo). The secondary aims included evaluation of the efficacy of TAP blocks in postoperative pain management, the measurement of time to first request for opioids, the measurement of length of hospital stay (LoS), and the documentation of postoperative nausea and/or vomiting. We searched for articles reporting the results of randomized controlled trials (RCTs) on the application of TAP block in colorectal surgery published before September 2021. Eight RCTs involving 615 patients were included in the meta-analysis. Seven articles reported the results of TAP blocks in laparoscopic surgery and eight in both laparoscopic and open surgery. The need for opioids and the intensity of pain at rest within 24 h after laparoscopic and combined (laparoscopic and open) surgeries were significantly lower in the TAP block group compared with the "no block" group. The intensity of pain during coughing within 24 hours after laparoscopic surgery was significantly lower in the TAP block groups compared to the groups without block. There were no statistically significant differences between the TAP block and "no block" groups in overall (over the entire hospital stay) postoperative opioid consumption and length of hospital stay after laparoscopic surgery, as well as in postoperative nausea and vomiting after laparoscopic and combined surgeries.
急性术后疼痛是结直肠手术术后早期最常见的问题之一。阿片类药物仍然是术后疼痛管理的基石，但它们常常会导致显著的副作用，如恶心和/或呕吐、镇静、尿潴留、结肠动力恢复延迟、呼吸抑制和术后肠梗阻。腹横肌平面（TAP）阻滞已广泛用于各种腹部手术的术后镇痛。本荟萃分析的主要目的是比较TAP阻滞组和对照组（安慰剂组）患者术后阿片类药物的需求量。次要目的包括评估TAP阻滞在术后疼痛管理中的疗效、首次要求使用阿片类药物的时间测量、住院时间（LoS）的测量以及术后恶心和/或呕吐的记录。我们检索了截至2021年9月之前发表的关于TAP阻滞在结直肠手术中应用的随机对照试验（RCT）结果的文章。八项RCT涉及615例患者，被纳入荟萃分析。七篇文章报告了TAP阻滞在腹腔镜手术中的结果，八篇文章报告了在腹腔镜和开放手术中的结果。与“未阻滞”组相比，TAP阻滞组在腹腔镜手术和联合（腹腔镜和开放）手术后24小时内的阿片类药物需求量和静息时的疼痛强度显著更低。与未阻滞组相比，TAP阻滞组在腹腔镜手术后24小时内咳嗽时的疼痛强度显著更低。在腹腔镜手术后的总体（整个住院期间）术后阿片类药物消耗量和住院时间，以及腹腔镜手术和联合手术后的术后恶心和呕吐方面，TAP阻滞组和“未阻滞”组之间没有统计学上的显著差异。
