Zewdu Dereje, Tantu Temesgen, Eanga Shamil, Tilahun Tamiru
Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Front Med (Lausanne). 2024 Jul 29;11:1399253. doi: 10.3389/fmed.2024.1399253. eCollection 2024.
Although laparoscopic cholecystectomy (LC) is a minimally invasive surgery, it can cause moderate to severe postoperative pain. Erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are considered effective means for pain management in such cases; however, there is inconclusive evidence regarding their analgesic efficacy. This meta-analysis aimed to compare the efficacy of ESP block and TAP block for pain control in LC.
We systematically searched Medline, PubMed, Scopus, Embase, and Google Scholar until 26 January 2024. All randomized clinical trials compared the efficacy of erector spinae plane block (ESPB) and transversus abdominis plane block (TAPB) for postoperative pain relief after LC. The primary outcomes were pain scores at rest and on movement at 1, 2, 6, 12, and 24 h postoperatively. The secondary outcomes were total opioid consumption, first analgesia request time, and rates of postoperative nausea and vomiting. We analyzed all the data using RevMan 5.4.
A total of 8 RCTs, involving 542 patients (271 in the ESPB group and 271 in the TAPB group), were included in the analysis. The ESP block demonstrated statistically significant lower pain scores at rest and on movement than the TAP block at all-time points except at the 1st and 6th h on movement postoperatively; however, these differences were not considered clinically significant. Additionally, patients who received the ESP block required less morphine and had a longer time before requesting their first dose of analgesia. There were no significant differences in postoperative nausea and vomiting incidence between the two groups.
In patients undergoing LC, there is moderate evidence to suggest that the ESP block is effective in reducing pain severity, morphine equivalent consumption, and the time before the first analgesia request when compared to the TAP block during the early postoperative period. PROSPERO CRD42024505635, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024505635.
尽管腹腔镜胆囊切除术（LC）是一种微创手术，但它会导致中度至重度的术后疼痛。竖脊肌平面（ESP）阻滞和腹横肌平面（TAP）阻滞被认为是此类病例疼痛管理的有效手段；然而，关于它们的镇痛效果，证据尚无定论。本荟萃分析旨在比较ESP阻滞和TAP阻滞在LC中控制疼痛的疗效。
我们系统检索了截至2024年1月26日的Medline、PubMed、Scopus、Embase和谷歌学术。所有随机临床试验比较了竖脊肌平面阻滞（ESPB）和腹横肌平面阻滞（TAPB）对LC术后疼痛缓解的疗效。主要结局是术后1、2、6、12和24小时静息和活动时的疼痛评分。次要结局是总阿片类药物消耗量、首次镇痛需求时间以及术后恶心呕吐发生率。我们使用RevMan 5.4分析所有数据。
共有8项随机对照试验纳入分析，涉及542例患者（ESPB组271例，TAPB组271例）。除术后活动后第1小时和第6小时外，ESP阻滞在所有时间点静息和活动时的疼痛评分均显著低于TAP阻滞；然而，这些差异不被认为具有临床意义。此外，接受ESP阻滞的患者所需吗啡较少，首次镇痛剂量的使用时间较长。两组术后恶心呕吐发生率无显著差异。
在接受LC的患者中，有中等证据表明，与TAP阻滞相比，ESP阻滞在术后早期可有效减轻疼痛严重程度、减少吗啡等效剂量消耗并延长首次镇痛需求时间。PROSPERO CRD42024505635，https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024505635 。
