Irvine Dylan, Rennie Christopher, Coughlin Emily, Thornton Imani, Mhaskar Rahul, Huang Jeffrey
HCA Florida Westside Hospital, Plantation, FL 33324, USA.
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759, USA.
Healthcare (Basel). 2024 Dec 22;12(24):2586. doi: 10.3390/healthcare12242586.
: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). : We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. : Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. : US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting.
当前文献已证明，腹横肌平面（TAP）阻滞对于一系列外科手术在减轻术后疼痛和减少阿片类药物使用方面具有益处。一些随机对照试验和回顾性研究比较了麻醉医生完成的超声引导下TAP阻滞（US-TAP）与外科医生完成的腹腔镜引导下TAP阻滞（LAP-TAP）。然而，这些研究结果尚未整合以改进建议并改善患者预后。我们的目标是整合并总结当前关于超声引导下（US-TAP，与腹腔镜引导相比（LAP-TAP））TAP阻滞在控制术后疼痛和减少阿片类药物使用方面疗效的文献。：我们对随机对照试验和回顾性研究进行了系统评价和荟萃分析，以评估US-TAP与LAP-TAP阻滞在控制术后疼痛和减少阿片类药物使用方面的效果。我们在PubMed/MEDLINE、CINAHL、Cochrane和科学网数据库中检索了所有符合检索标准的文章，直至2024年2月文章提取之时。主要结局变量为术后疼痛评分和阿片类药物使用量。次要结局变量为并发症、实施阻滞所需时间、住院时间（LOS）以及实施阻滞的成本。：在最初识别的1673篇文章中，18项研究符合纳入标准进行评估。在纳入的研究中，分别有88.9%和77.8%的研究发现US-TAP组和LAP-TAP组在术后疼痛评分或阿片类药物使用量方面无显著差异。六项研究（33.3%）发现LAP-TAP的实施速度比US-TAP快。荟萃分析表明，两组之间在术后疼痛评分或阿片类药物使用量方面无统计学显著差异，但显示US-TAP组的阻滞时间明显更长。：US-TAP和LAP-TAP阻滞在减轻术后疼痛和减少阿片类药物使用方面可能效果相当。在围手术期，LAP-TAP可能比US-TAP耗时更少、成本效益更高且更可行。
