Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Division of Colorectal Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Int J Surg. 2022 Aug;104:106825. doi: 10.1016/j.ijsu.2022.106825. Epub 2022 Aug 8.
The effectiveness of transversus abdominis plane block (TAP) on pain management after laparoscopic colorectal surgery (CRS) remains unclear since the only relevant meta-analysis on this topic did not separate laparoscopic CRS from open CRS. The aim of the study was to compare the analgesic efficacy and safety of TAP with non-TAP in patients undergoing laparoscopic CRS.
Four databases were searched for randomized controlled trials (RCTs) on this topic using relevant keywords. Two authors independently completed evidence selection, data extraction, and critical appraisal. Available data were pooled in the random-effects model, and point estimates with 95% confidence interval (CI) were reported for postoperative pain at rest and on coughing, opioid consumption, length of hospital stay, and adverse events.
A total of 14 RCTs (n = 1216) contributed to the present synthesis. Pooled result showed that patients in the TAP group had lower pain at rest than those in the non-TAP group at postoperative 2-h (mean difference [MD] = -1.42; P < 0.05), 4-h (MD = -0.97; P < 0.05), 12-h (MD = -0.75; P < 0.05), and 24-h (MD = -0.61; P < 0.05). Patients in the TAP group also had lower postoperative pain on coughing than those in the non-TAP group on the first day (MD = -1.02; P < 0.05). Moreover, TAP had lesser postoperative opioid consumption than non-TAP (standardized mean difference, -0.26; P < 0.05; I-square = 20%), and there were non-significant differences in hospital stay and adverse event between the two groups.
Intraoperative TAP is a safe and feasible pain management for laparoscopic CRS, particularly it is recommended when patient-controlled analgesia is not delivered. Therefore, laparoscopic TAP block might be a favorable administered strategy.
经腹横肌平面阻滞（TAP）在腹腔镜结直肠手术后（CRS）的疼痛管理中的有效性尚不清楚，因为该主题的唯一相关荟萃分析并未将腹腔镜 CRS 与开腹 CRS 分开。本研究的目的是比较 TAP 与非 TAP 在接受腹腔镜 CRS 的患者中的镇痛效果和安全性。
使用相关关键字在四个数据库中搜索了有关该主题的随机对照试验（RCT）。两名作者独立完成证据选择、数据提取和关键评估。将可用数据汇总到随机效应模型中，并报告术后静息和咳嗽时的术后疼痛、阿片类药物消耗、住院时间和不良事件的点估计值和 95%置信区间（CI）。
共有 14 项 RCT（n=1216）为本次综合研究做出了贡献。汇总结果表明，与非 TAP 组相比，TAP 组患者在术后 2 小时（MD=-1.42；P<0.05）、4 小时（MD=-0.97；P<0.05）、12 小时（MD=-0.75；P<0.05）和 24 小时（MD=-0.61；P<0.05）时静息时疼痛较低。TAP 组患者在术后第 1 天咳嗽时的术后疼痛也低于非 TAP 组（MD=-1.02；P<0.05）。此外，与非 TAP 相比，TAP 术后阿片类药物消耗较少（标准化均数差，-0.26；P<0.05；I-square=20%），且两组间住院时间和不良事件无显著差异。
术中 TAP 是腹腔镜 CRS 安全且可行的疼痛管理方法，特别是在未使用患者自控镇痛时推荐使用。因此，腹腔镜 TAP 阻滞可能是一种有利的管理策略。
