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A meta-analysis of laparoscopic versus ultrasound-guided transversus abdominis plane block in laparoscopic colorectal surgery

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Abstract

Background

Enhanced recovery programmes in laparoscopic colorectal surgery (LCS) employ combined approaches to achieve postoperative analgesia. Transversus abdominis plane (TAP) block is a locoregional anaesthetic technique that may reduce postoperative pain.

Aims

To perform a systematic review and meta-analysis to compare the effectiveness of laparoscopic- versus ultrasound-guided TAP block in LCS.

Methods

Databases were searched for relevant articles from inception until March 2022. All randomised controlled trials (RCTs) that compared laparoscopic (LTB) versus ultrasound-guided (UTB) TAP blocks in LCS were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included pain scores at 24 h postoperatively, operative time, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates.

Results

Three RCTs were included capturing 219 patients. Studies were clinically heterogenous. On random effects analysis, LTB was associated with significantly lower narcotic consumption (SMD − 0.30 mg, 95% CI = − 0.57 to − 0.03, p = 0.03) and pain scores (SMD − 0.29, 95% CI = − 0.56 to − 0.03, p = 0.03) at 24 h. However, there were no differences in operative time (SMD − 0.09 min, 95% CI = − 0.40 to 0.22, p = 0.56), PONV (OR = 0.97, 95% CI = 0.36 to 2.65, p = 0.96) or complication (OR = 1.30, 95% CI = 0.64 to 2.64, p = 0.47) rates.

Conclusions

LTB is associated with significantly less narcotic usage and pain at 24 h postoperatively but similar PONV, operative time and complication rates, compared to UTB. However, the data were inconsistent, and our findings require further investigation. LTB obviates the need for ultrasound devices whilst also decreasing procedure logistical complexity.

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Availability of data and material

N/A.

Code availability

RevMan, version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.

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Author notes

  1. Amy Copperthwaite and Shaheel Mohammad Sahebally are joint first authors.

Authors and Affiliations

  1. Department of Colorectal Surgery, Beaumont Hospital, 9, Dublin, Ireland

    Amy Copperthwaite, Shaheel Mohammad Sahebally, Zeeshan Muhammad Raza, Liam Devane, Niamh McCawley, David Kearney, John Burke & Deborah McNamara

  2. Royal College of Surgeons, St Stephen’s Green, Dublin 2, Dublin, Ireland

    Amy Copperthwaite, Shaheel Mohammad Sahebally, Zeeshan Muhammad Raza, Liam Devane, Niamh McCawley, David Kearney, John Burke & Deborah McNamara

  3. Department of Otolaryngology, Sligo University Hospital, Sligo, Ireland

    Amy Copperthwaite

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Contributions

Conceived and designed experiments: SMS, AC. Performed the experiments: SMS, AC. Analysed the data: All authors. Wrote the manuscript: All authors.

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Correspondence to Amy Copperthwaite.

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Copperthwaite, A., Sahebally, S.M., Raza, Z.M. et al. A meta-analysis of laparoscopic versus ultrasound-guided transversus abdominis plane block in laparoscopic colorectal surgery. Ir J Med Sci 192, 795–803 (2023). https://doi.org/10.1007/s11845-022-03017-7

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