The Analgesic Efficacy of Subcostal Transversus Abdominis Plane Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical Gastrectomy

Wu, Yiquan; Liu, Fuli; Tang, Hongli; Wang, Quanguang; Chen, Limei; Wu, Hui; Zhang, Xuezheng; Miao, Jianxia; Zhu, Meizhen; Hu, Chenggang; Goldsworthy, Mark; You, Jing; Xu, Xuzhong

doi:10.1213/ane.0b013e318297fcee

Cited by 107 publications

(94 citation statements)

References 22 publications

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“…Only three studies [41][42][43] addressed the comparison between TAP block and epidural anesthesia, and none of them showed any significant differences between the two techniques ( Table 2). Only one RCT 43 investigated eight-hour pain score, and one trial 43 reported the 24-hr morphine consumption.…”

Section: Transversus Abdominal Plane Block Vs Epidural Analgesiamentioning

confidence: 99%

“…Only one RCT 43 investigated eight-hour pain score, and one trial 43 reported the 24-hr morphine consumption. It was not possible to perform subgroup analysis for this comparison.…”

Section: Transversus Abdominal Plane Block Vs Epidural Analgesiamentioning

confidence: 99%

“…16,29,36,38,[40][41][42][43]52 Compared with the control group, TAP block showed no difference in reducing the six-hour pain score 16,29,36,38,41,43 (-0.1; 95% CI, -1.4 to 1.3; P = 0.95), 12-hr pain score 16,38,41,52 (1.9, 95% CI, -4.2 to 0.4; P = 0.11), 24-hr pain score 16,29,36,38,[41][42][43]52 (-0.8; 95% CI, -2.0 to 0.4; P = 0.18), or 24-hr morphine consumption 16,29,36,38,43,52 (-14.7 mg; 95% CI, -37.8 to 8.4; P = 0.21) ( Table 2). Only one trial 16 performed TAP block from inside the abdominal wall; consequently, it was not possible to perform subgroup analysis for this comparison.…”

Section: Transversus Abdominal Plane Block In Abdominal Surgerymentioning

confidence: 99%

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Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

133

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Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. Source We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i.e., placebo, epidural analgesia, intrathecal morphine (ITM), and ilioinguinal nerve block after abdominal surgery]. Meta-analyses were performed on postoperative pain scores at rest at six, 12, and 24 hr (visual analogue scale, 0-10) and on 24-hr opioid consumption. Principal findings In the 51 trials identified, compared with placebo, TAP block reduced the VAS for pain at six hours by 1.4 (95% confidence interval [CI], -1.9 to -0.8; P\0.001), at 12 hr by 2.0 (95% CI, -2.7 to -1.4; P\0.001), and at 24 hr by 1.2 (95% CI, -1.6 to -0.8; P \ 0.001). Similarly, compared with placebo, TAP block reduced morphine consumption at 24 hr after surgery (mean difference, -14.7 mg; 95% CI, -18.4 to -11.0; P \0.001). We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery, appendectomy, inguinal surgery, bariatric surgery, and urological surgery. Nevertheless, separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy. Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption. It may have particular utility when neuraxial techniques or opioids are contraindicated. RésuméObjectif Le bloc dans le plan du muscle transverse de l'abdomen (ou TAP bloc) a été décrit comme une technique efficace de contrô le de la douleur après une chirurgie abdominale. Nous avons réalisé une revue systématique et une méta-analyse des études randomisées contrô lées (ERC) pour faire un état des lieux du nombre croissant d'études

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Section: Transversus Abdominal Plane Block Vs Epidural Analgesiamentioning

confidence: 99%

“…Only one RCT 43 investigated eight-hour pain score, and one trial 43 reported the 24-hr morphine consumption. It was not possible to perform subgroup analysis for this comparison.…”

Section: Transversus Abdominal Plane Block Vs Epidural Analgesiamentioning

confidence: 99%

Section: Transversus Abdominal Plane Block In Abdominal Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

133

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“…25,27,28 Subcostal TAP blocks are performed to provide analgesia in the upper quadrants of the abdominal wall. 29,30 The analgesic efficacy of TAP blocks can be prolonged by intermittent boluses or continuous infusion of local anesthetic through multihole catheters placed between the internal oblique and transversus abdominis muscle. [31][32][33] Rectus sheath blocks have also used but the evidence base is mainly for gynecologic and urologic surgery and pediatric hernias.…”

Section: Local Anesthetic Drugs Administered Peripherallymentioning

confidence: 99%

Optimal Analgesia During Major Open and Laparoscopic Abdominal Surgery

Fawcett

Baldini

2015

Anesthesiology Clinics

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“…A recent systematic review showed the Transversus Abdominis Plane (TAP) block is safe, reduces postoperative opiate requirements, nausea/vomiting and the severity of pain after abdominal surgery [18]. It has been shown that a single-injection subcostal TAP block to be more effective than IV opioid analgesia in radical gastrectomies as Well [19]. At our center, bilateral TAP blocks are performed under ultrasound guidanceprior to surgical incision.…”

Section: Introductionmentioning

confidence: 99%

Shifting the Management of Post Bariatric Hernia Repairs with Abdominal Procedures from In-Patient to Out-Patient

2017

JACCOA

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Research Articlemany forms of hernias are found in these patients. In a series of of 325 consecutive patients undergoing laparoscopic gastric bypass, and 26 (8%) had a ventral hernia found at laparoscopic gastric bypass [4]. Trocar site hernias are also more common in this patient population. Host factors such as obesity predispose these patients to poor outcomes, however, technical factors including need for large trocars, multiple fascial punctures, fascial stretching and incomplete fascial closure matriculate into multiple abdominal hernias [5].

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The Analgesic Efficacy of Subcostal Transversus Abdominis Plane Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical Gastrectomy

Abstract: Single-injection subcostal TAP block was more effective than IV opioid analgesia, while continuous thoracic epidural analgesia was more effective than the single-injection subcostal TAP block.

Cited by 107 publications

References 22 publications

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Optimal Analgesia During Major Open and Laparoscopic Abdominal Surgery

Shifting the Management of Post Bariatric Hernia Repairs with Abdominal Procedures from In-Patient to Out-Patient

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