Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Plastic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
J Invest Surg. 2022 Sep;35(9):1711-1722. doi: 10.1080/08941939.2022.2098426. Epub 2022 Jul 17.
Regional anesthesia technique has been reported to exert excellent analgesic efficacy for various surgeries. Erector spinae plane block (ESPB) and transversus abdominis plane (TAP) block are good ways to relieve postoperative pain after abdominal surgery. However, the analgesic efficacy between them remains controversial. This meta-analysis evaluated the analgesic effect between these two blocks in abdominal surgery with statistical and clinical interpretation.
PubMed, Web of Science, the Cochrane Library, ClinicalTrials.gov register, and Embase databases were systematically searched by two independent investigators from the inception to December 2021.
10 randomized controlled trials (RCTs) comprising 570 patients were included in the final meta-analysis. Meta-analysis revealed that ESPB decreased the opioid consumption and improved the pain scores during the first 24 postoperative hours compared with TAP groups statistically, while the magnitude of this difference did not reach the clinically significant threshold (10 mg of intravenous morphine consumption and 1.3 cm on the VAS scale). In addition, ESPB prolonged blockade duration and decreased the occurrence of postoperative nausea and vomiting (PONV). However, it did not improve the patients' satisfaction.
Although ESPB does not provide better clinical analgesia than the TAP block, it could be a comparable nerve block technique for abdominal wall analgesia.
区域麻醉技术已被报道在各种手术中具有出色的镇痛效果。竖脊肌平面阻滞（ESPB）和腹横肌平面阻滞（TAP）是缓解腹部手术后疼痛的有效方法。然而，它们之间的镇痛效果仍存在争议。本荟萃分析通过统计学和临床解释评估了这两种阻滞方法在腹部手术中的镇痛效果。
两位独立的研究者从成立到 2021 年 12 月，系统地检索了 PubMed、Web of Science、Cochrane 图书馆、ClinicalTrials.gov 注册和 Embase 数据库。
最终的荟萃分析纳入了 10 项随机对照试验（RCT），共 570 例患者。荟萃分析显示，与 TAP 组相比，ESPB 统计学上减少了术后 24 小时内的阿片类药物消耗和疼痛评分，而这种差异的幅度没有达到临床显著阈值（静脉注射吗啡消耗 10mg 和 VAS 评分 1.3cm）。此外，ESPB 延长了阻滞持续时间，并降低了术后恶心和呕吐（PONV）的发生。然而，它并没有提高患者的满意度。
虽然 ESPB 提供的临床镇痛效果并不优于 TAP 阻滞，但它可能是一种可与腹壁镇痛相媲美的神经阻滞技术。
