Nair Abhijit, Dudhedia Ujjwalraj, Rangaiah Manamohan, Borkar Nitin
Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman.
Department of Anaesthesiology and Pain Management, DR. L.H. Hiranandani Hospital, Powai Mumbai, Maharashtra State, India.
Indian J Anaesth. 2023 Apr;67(4):331-342. doi: 10.4103/ija.ija_43_23. Epub 2023 Apr 10.
Ultrasound-guided transversalis fascia plane block (TFPB) has been used for providing postoperative analgesia after various lower abdominal surgeries like iliac crest bone harvesting, inguinal hernia repair, caesarean section and appendicectomy. After registering the protocol in PROSPERO, various databases like PubMed/Medline, Ovid, CENTRAL and clinicaltrials.gov were searched for randomized controlled trials and observational, comparative studies till October 2022. The risk of bias (RoB-2) scale was used to assess the quality of evidence. The database searched identified 149 articles. Out of these, 8 studies were identified for qualitative analysis and 3 studies were TFPB was compared to control in patients undergoing caesarean section were selected for quantitative analysis. At 12 hours, pain scores were significantly less in TFPB group when compared to control on movement with no heterogeneity. At other times, the pain scores were comparable. 24-hr opioid consumption was significantly less in TFPB group when compared to control with significant heterogeneity. Time to rescue analgesia was significantly less in TFPB group when compared to control with significant heterogeneity. Number of patients requiring rescue analgesia were significantly less in TFPB group when compared to control with no heterogeneity. Postoperative nausea/vomiting (PONV) was significantly less in TFPB group when compared to control with minimal heterogeneity. In conclusion, TFPB is a safe block which provides opioid-sparing postoperative analgesia and a delayed time to rescue analgesia with no significant difference in pain scores and lesser PONV postoperatively when compared to control in patients undergoing caesarean section.
超声引导下腹横筋膜平面阻滞(TFPB)已被用于为各种下腹部手术后提供术后镇痛,如髂嵴取骨、腹股沟疝修补术、剖宫产和阑尾切除术。在PROSPERO中注册该方案后,检索了PubMed/Medline、Ovid、CENTRAL和clinicaltrials.gov等各种数据库,以查找截至2022年10月的随机对照试验以及观察性、比较性研究。使用偏倚风险(RoB - 2)量表评估证据质量。检索数据库共识别出149篇文章。其中,8项研究被确定用于定性分析,3项将TFPB与剖宫产患者的对照组进行比较的研究被选作定量分析。在12小时时,TFPB组在活动时的疼痛评分与对照组相比显著更低,且无异质性。在其他时间点,疼痛评分相当。与对照组相比,TFPB组24小时阿片类药物消耗量显著更低,存在显著异质性。与对照组相比,TFPB组的补救镇痛时间显著更短,存在显著异质性。与对照组相比,TFPB组需要补救镇痛的患者数量显著更少,且无异质性。与对照组相比,TFPB组术后恶心/呕吐(PONV)显著更少,异质性最小。总之,TFPB是一种安全的阻滞方法,与剖宫产患者的对照组相比,它能提供节省阿片类药物的术后镇痛以及延迟的补救镇痛时间,疼痛评分无显著差异,术后PONV也更少。