Wegner Bruno F M, Wegner Gustavo R M, Cumming Henrique, Henrique Gabrielle, Andrade Naieli, Cordeiro Heidi, Ferreira Carlos, Souza do Nascimento Tatiana
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Universidade Federal da Fronteira Sul (UFFS), Passo Fundo, Brazil.
Surg Endosc. 2025 Jul 21. doi: 10.1007/s00464-025-11925-9.
The Transversus Abdominis Plane block, performed using either laparoscopy-assisted or ultrasound-guided techniques, has emerged as a valuable option for managing postoperative pain in laparoscopic abdominal surgeries. Ultrasound guidance improves the accuracy and safety of anaesthetic administration, whereas the laparoscopy-assisted technique enables direct visualization of the injection site and anaesthetic dispersion, potentially increasing precision and reducing performance time. Previous meta-analyses have yielded limited results, largely due to their narrow focus on specific surgeries or heterogeneous study designs.
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effectiveness of LTAP and UTAP in adult patients undergoing laparoscopic abdominal surgery. Databases searched included MEDLINE, Cochrane Library, Embase, and Web of Science, following PRISMA and Cochrane Handbook guidelines. Eligible studies enrolled adult patients (P) undergoing laparoscopic abdominal surgery who received LTAP (I) or UTAP (C), with outcomes including postoperative pain and analgesic requirements (O).
Thirteen RCTs comprising 1254 patients undergoing cholecystectomy, bariatric surgery, or colorectal surgery were analysed. Laparoscopy-assisted Transversus Abdominis Plane block trended to marginally lower pain scores at 24 h (mean difference - 0.25, 95% confidence interval - 0.51 to 0.02, P = 0.066) and required significantly less time for performance (mean difference - 6.78 min, 95% confidence interval - 8.69 to - 4.87, P < 0.000001). No significant differences were observed in cumulative morphine consumption, time to the first analgesic request, or total surgical duration.
Both techniques provide effective postoperative analgesia. The laparoscopy-assisted approach may provide a procedural efficiency advantage due to shorter performance time. These findings support its application across a range of laparoscopic abdominal surgeries and underscore the need for further research to consolidate these advantages.
使用腹腔镜辅助或超声引导技术进行的腹横肌平面阻滞，已成为管理腹腔镜腹部手术术后疼痛的一种有价值的选择。超声引导提高了麻醉给药的准确性和安全性，而腹腔镜辅助技术能够直接观察注射部位和麻醉剂的扩散情况，可能会提高精确度并缩短操作时间。以往的荟萃分析结果有限，主要是因为它们局限于特定手术或研究设计的异质性。
进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以比较腹腔镜辅助腹横肌平面阻滞（LTAP）和超声引导腹横肌平面阻滞（UTAP）在接受腹腔镜腹部手术的成年患者中的有效性。按照PRISMA和Cochrane手册指南，检索的数据库包括MEDLINE、Cochrane图书馆、Embase和科学网。符合条件的研究纳入接受腹腔镜腹部手术的成年患者（P），他们接受了LTAP（I）或UTAP（C），结局包括术后疼痛和镇痛需求（O）。
分析了13项RCT，共1254例接受胆囊切除术、减肥手术或结直肠手术的患者。腹腔镜辅助腹横肌平面阻滞在24小时时疼痛评分有略低的趋势（平均差值 -0.25，95%置信区间 -0.51至0.02，P = 0.066），且操作所需时间显著更短（平均差值 -6.78分钟，95%置信区间 -8.69至 -4.87，P < 0.000001）。在累积吗啡消耗量、首次镇痛需求时间或总手术时长方面未观察到显著差异。
两种技术均能提供有效的术后镇痛。腹腔镜辅助方法可能因操作时间较短而具有程序效率优势。这些发现支持其在一系列腹腔镜腹部手术中的应用，并强调需要进一步研究以巩固这些优势。
