Aldalati Abdullah Yousef, Hussein Ayham Mohammad, Nguyen Dang, Sabet Cameron John, Hammadeh Bara M, Abo-Elenien Wesam I, Kamal Zaid, Odat Ramez M
Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Faculty of Medicine, Al-Balqa' Applied University, Salt, Jordan.
Ir J Med Sci. 2025 Feb;194(1):323-331. doi: 10.1007/s11845-024-03861-9. Epub 2025 Jan 6.
Postoperative pain following laparoscopic cholecystectomy (LC) is a major concern. The transversus abdominis plane block (TAPB) is one of the anesthetic techniques that has been developed to address this issue. The TAPB can be delivered by the guidance of either ultrasound (UTAPB) or laparoscopic (LTAPB). Our aim is to compare the efficacy of these guidance methods in reducing postoperative pain after LC.
A systematic search was performed in PubMed, Scopus, Cochrane, and Web of Science databases from inception to June 2024 for randomized studies comparing the delivery of TAPB under ultrasound and laparoscopic guidance. Data analysis was conducted using Review Manager V5.4.
Five randomized studies were included in our study. UTAPB was significantly more effective in reducing postoperative pain after 6 h compared to LTAPB (MD = - 0.38, 95% CI, - 0.67 to 0.09, p = 0.01). However, UTAPB was insignificantly more effective than LTAPB in reducing postoperative pain after 12 h (MD = - 0.14, 95% CI, - 0.44 to 0.17, p = 0.39), 24 h (MD = - 0.09, 95% CI, - 0.41 to 0.23, p = 0.60), and 48 h (MD = - 0.12, 95% CI, - 0.44 to 0.19, p = 0.44). UTAPB insignificantly resulted in decreased opioid consumption (SMD: - 0.09; 95% CI: - 0.42, 0.25; p = 0.62) and less postoperative nausea and vomiting (OR = 0.73, 95% CI, 0.21 to 2.51, p = 0.62) in comparison with LTAPB.
Ultrasound guidance of TAPB offers superior pain relief in the setting of LC, especially in the early postoperative period. Further trials are needed to prove and support the results.
腹腔镜胆囊切除术（LC）后的术后疼痛是一个主要问题。腹横肌平面阻滞（TAPB）是为解决这一问题而开发的麻醉技术之一。TAPB可以在超声引导（UTAPB）或腹腔镜引导（LTAPB）下实施。我们的目的是比较这些引导方法在减轻LC术后疼痛方面的疗效。
从数据库建立至2024年6月，在PubMed、Scopus、Cochrane和Web of Science数据库中进行系统检索，以查找比较超声引导和腹腔镜引导下实施TAPB的随机研究。使用Review Manager V5.4进行数据分析。
我们的研究纳入了五项随机研究。与LTAPB相比，UTAPB在术后6小时减轻术后疼痛方面显著更有效（MD = -0.38，95%CI，-0.67至-0.09，p = 0.01）。然而，在术后12小时（MD = -0.14，95%CI，-0.44至0.17，p = 0.39）、24小时（MD = -0.09，95%CI，-0.41至0.23，p = 0.60）和48小时（MD = -0.12，95%CI，-0.44至0.19，p = 0.44），UTAPB在减轻术后疼痛方面比LTAPB效果略好但无显著差异。与LTAPB相比，UTAPB在减少阿片类药物用量（标准化均数差：-0.09；95%CI：-0.42，0.25；p = 0.62）和术后恶心呕吐方面（比值比 = 0.73，95%CI，0.21至2.51，p = 0.62）效果略好但无显著差异。
TAPB的超声引导在LC手术中能提供更好的疼痛缓解，尤其是在术后早期。需要进一步的试验来证实和支持这些结果。
