Garo Maria L, Ruggiero Alessandro, DI Folco Marta, Costa Fabio, Migliorelli Sabrina, Pascarella Giuseppe, Strumia Alessandro, Nasso Giuseppe, Cataldo Rita, Carassiti Massimiliano, Agrò Felice E
Research Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
Research Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy -
Minerva Anestesiol. 2025 Nov;91(11):1064-1071. doi: 10.23736/S0375-9393.25.19061-5.
Postoperative analgesia is a crucial component in optimized postoperative recovery protocols, especially in laparoscopic surgery, a minimally invasive technique that reduces surgical trauma and accelerates recovery. The transversus abdominis plane block has been proposed as an alternative to thoracic epidural analgesia, which, although effective, is associated with significant side effects such as hypotension, urinary retention, and muscle weakness. However, the current literature lacks a systematic synthesis directly comparing these two analgesic techniques following laparoscopic surgery of the abdomen. This study aims to evaluate the effectiveness of transversus abdominis plane block to thoracic epidural analgesia in postoperative pain control, with a particular focus on functional outcomes and hospital length of stay. A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD42024508473). Randomized controlled trials (RCTs) comparing the transversus abdominis plane block and thoracic epidural analgesia in adult patients undergoing laparoscopic surgery were selected. The primary outcome analyzed was static pain at 24 hours, while secondary outcomes included static pain at 0-2 hours, dynamic pain at 0-2 and 24-36 hours, opioid consumption, time to first mobilization, time to first flatus, and hospital length of stay. A total of 264 articles were identified, of which five RCTs (N.=400 patients) met the inclusion criteria. The analysis showed no significant differences in pain control between the transversus abdominis plane block and thoracic epidural analgesia in the first 24 postoperative hours (Cohen's d=-0.12, 95% CI: -0.48; 0.24) or in total opioid consumption (Cohen's d=-0.09, 95% CI: -0.45; 0.26). However, the transversus abdominis plane block was associated with faster functional recovery, with a significant reduction in time to first flatus (Cohen's d=-0.61, 95% CI: -1.15; -0.07, P=0.027) and time to first mobilization (Cohen's d=-0.76, 95% CI: -1.25; -0.27, P=0.003). No significant differences were found in hospital length of stay (Cohen's d=-0.14, 95% CI: -0.50; 0.22). The transversus abdominis plane block provides effective analgesia and promotes faster functional recovery compared to thoracic epidural analgesia. Given these advantages, it may represent a valid alternative in optimized postoperative recovery protocols. However, further high-quality studies are needed to confirm its efficacy and define standardized guidelines for its use in laparoscopic surgery.
术后镇痛是优化术后恢复方案的关键组成部分，尤其是在腹腔镜手术中，这是一种微创技术，可减少手术创伤并加速恢复。腹横肌平面阻滞已被提议作为胸段硬膜外镇痛的替代方法，胸段硬膜外镇痛虽然有效，但会伴有低血压、尿潴留和肌肉无力等显著副作用。然而，目前的文献缺乏对这两种镇痛技术在腹部腹腔镜手术后进行直接比较的系统综述。本研究旨在评估腹横肌平面阻滞与胸段硬膜外镇痛在术后疼痛控制方面的有效性，特别关注功能结局和住院时间。根据PRISMA指南进行了系统综述和荟萃分析，并在PROSPERO数据库（CRD42024508473）中进行了注册。选择了比较腹横肌平面阻滞与胸段硬膜外镇痛在接受腹腔镜手术的成年患者中的随机对照试验（RCT）。分析的主要结局是术后24小时的静态疼痛，而次要结局包括0至2小时的静态疼痛、0至2小时和24至36小时的动态疼痛、阿片类药物消耗量、首次活动时间、首次排气时间和住院时间。共确定了264篇文章，其中五项RCT（N = 400例患者）符合纳入标准。分析显示，在术后的前24小时内，腹横肌平面阻滞与胸段硬膜外镇痛在疼痛控制方面无显著差异（Cohen's d = -0.12，95% CI：-0.48；0.24），在总阿片类药物消耗量方面也无显著差异（Cohen's d = -0.09，95% CI：-0.45；0.26）。然而，腹横肌平面阻滞与更快的功能恢复相关，首次排气时间显著缩短（Cohen's d = -0.61，95% CI：-1.15；-0.07，P = 0.027），首次活动时间也显著缩短（Cohen's d = -0.76，95% CI：-1.25；-0.27，P = 0.003）。住院时间方面未发现显著差异（Cohen's d = -0.14，95% CI：-0.50；0.22）。与胸段硬膜外镇痛相比，腹横肌平面阻滞提供了有效的镇痛效果，并促进了更快的功能恢复。鉴于这些优点，它可能是优化术后恢复方案中的一种有效替代方法。然而，需要进一步的高质量研究来证实其疗效，并确定其在腹腔镜手术中使用的标准化指南。
