Hytham Ks Hamid1, Sameh H Emile2, Alan A Saber3, Jaime Ruiz-Tovar4, Vasilis Minas5, Thomas E Cataldo6. 1. Department of Surgery, Soba University Hospital, Khartoum, Sudan. Electronic address: kujali2@gmail.com. 2. Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt. 3. Bariatric & Metabolic Surgery Unit, Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ. 4. Bariatric Surgery Unit, Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain. 5. Centre for Endometriosis and Minimally Invasive Gynecology (CEMIG), Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK. 6. Division of Colon & Rectum Surgery, Beth Israel-Deaconess Health Medical Center, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Optimal postoperative pain therapy for patients undergoing minimally invasive surgery remains controversial. The aim of this meta-analysis was to compare the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (L-TAP) with other analgesic alternatives in adults undergoing minimally invasive surgery. STUDY DESIGN: A systematic literature search of several databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines through March 9, 2020, to identify randomized controlled trials (RCTs) reporting on L-TAP. Primary outcomes were pain scores at rest and movement at 24 hours postoperatively. Secondary outcomes included postoperative pain scores at 0 to 4 and 48 hours, opioid consumption, hospital stay, functional recovery, patient satisfaction, and adverse events. RESULTS: Nineteen RCTs with 1,983 patients were included. All trials compared L-TAP with ultrasound-guided transversus abdominis plane block (US-TAP), local infiltration analgesia (LIA), or inactive control; none controlled for epidural analgesia. Methodologic quality of these RCTs ranged from moderate to high. L-TAP provided comparable pain control compared with US-TAP, and better early pain control compared with LIA. Recovery parameters, 24-hour opioid consumption, and postoperative nausea and vomiting (PONV) were comparable between L-TAP and US-TAP. Meanwhile, 24-hour opioid consumption, PONV incidence, hospital stay, and patient satisfaction favored L-TAP compared with LIA. None of the studies reported adverse events related to the L-TAP procedure. CONCLUSIONS: L-TAP is safe, and superior to LIA with respect to early pain control, opioid consumption, and patient satisfaction in adults undergoing minimally invasive surgery. Given its equivalence to US-TAP, L-TAP can be used as a safer and pragmatic alternative to epidural analgesia in this patient population.
BACKGROUND: Optimal postoperative pain therapy for patients undergoing minimally invasive surgery remains controversial. The aim of this meta-analysis was to compare the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (L-TAP) with other analgesic alternatives in adults undergoing minimally invasive surgery. STUDY DESIGN: A systematic literature search of several databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines through March 9, 2020, to identify randomized controlled trials (RCTs) reporting on L-TAP. Primary outcomes were pain scores at rest and movement at 24 hours postoperatively. Secondary outcomes included postoperative pain scores at 0 to 4 and 48 hours, opioid consumption, hospital stay, functional recovery, patient satisfaction, and adverse events. RESULTS: Nineteen RCTs with 1,983 patients were included. All trials compared L-TAP with ultrasound-guided transversus abdominis plane block (US-TAP), local infiltration analgesia (LIA), or inactive control; none controlled for epidural analgesia. Methodologic quality of these RCTs ranged from moderate to high. L-TAP provided comparable pain control compared with US-TAP, and better early pain control compared with LIA. Recovery parameters, 24-hour opioid consumption, and postoperative nausea and vomiting (PONV) were comparable between L-TAP and US-TAP. Meanwhile, 24-hour opioid consumption, PONV incidence, hospital stay, and patient satisfaction favored L-TAP compared with LIA. None of the studies reported adverse events related to the L-TAP procedure. CONCLUSIONS: L-TAP is safe, and superior to LIA with respect to early pain control, opioid consumption, and patient satisfaction in adults undergoing minimally invasive surgery. Given its equivalence to US-TAP, L-TAP can be used as a safer and pragmatic alternative to epidural analgesia in this patient population.