Transversus Abdominis Plane Block for Post Hysterectomy Pain: A Systematic Review and Meta-Analysis

Bacal, Vanessa; Rana, Urvi; McIsaac, Daniel I.; Chen, Innie

doi:10.1016/j.jmig.2018.04.020

Cited by 52 publications

(36 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Three recent systematic reviews found that TAP blocks provide significant postoperative early and 24-h pain control compared with placebo or no block among women who undergo a hysterectomy. There was reduced morphine consumption among patients who underwent total abdominal hysterectomy but not for total laparoscopic hysterectomy [60][61][62].…”

Section: Hysterectomymentioning

confidence: 99%

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

Uppal

Sancheti

Kalagara

2019

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Purpose of Review This article aims to review the anatomy relevant to the ultrasound techniques of the transversus abdominis plane (TAP) block and rectus sheath block (RSB). We discuss their analgesic efficacy for various surgical procedures, both as single shot and as a continuous infusion via catheters. Recent Findings RSB provides superior analgesia to local infiltration and has an opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic surgery. There is no high-quality evidence comparing RSB with epidural analgesia. Intermittent bolus through catheters appears to be more effective than continuous infusion for prolonged analgesia. Similarly, ultrasoundguided TAP block provides postoperative analgesic benefit after abdominal laparotomy or laparoscopy and cesarean delivery when long-acting neuraxial opioids are not used or contraindicated. Adding adjuvant such as dexamethasone and dexmedetomidine to local anesthetic prolongs the duration of TAP and RSB blocks and improves their efficacy. Summary Use of ultrasound guidance makes the RSB and TAP blocks more reliable. Single-shot infiltration is useful for less extensive surgical procedures, while catheters are a useful alternative when thoracic epidural analgesia is contraindicated.

show abstract

Section: Hysterectomymentioning

confidence: 99%

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

Uppal

Sancheti

Kalagara

2019

Curr Anesthesiol Rep

View full text Add to dashboard Cite

show abstract

“…It is important to balance the risks and benefits of epidural analgesia for postoperative pain control. Truncal blocks particularly transversus abdominis plane block are efficacious in terms of reduction in pain and opioid requirement up to 24 hours postoperatively for patients undergoing hysterectomy 37 . Wound infiltration using local anaesthetics is easy to perform and carries fewer complication risks.…”

Section: Perioperative Analgesiamentioning

confidence: 99%

Enhanced recovery for gynaecological surgery: a review

Yim

Lam

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

View full text Add to dashboard Cite

We review various aspects of enhanced recovery after surgery for gynaecological patients, including patient education and counselling, preoperative assessment and optimisation, preoperative fasting and nutrition, bowel preparation, thromboembolism prophylaxis, perioperative analgesia, peritoneal drains and urinary catheters, postoperative nausea and vomiting, hypothermia prevention, early feeding and early mobilisation, and implementation of enhanced recovery after surgery.

show abstract

“…Multimodal analgesia has been demonstrated to decrease post-operative opioid use with improvement in overall length of stay 3–5. Post-operative opioid usage is associated with somnolence, nausea, vomiting, and delayed return of gastric functioning 6–8. Uptake of epidural analgesia for regional post-operative pain control has been limited due to operative time, contraindications, and technical constraints, which has led to the investigation of alternative methods to decrease post-operative pain 3 9 10…”

Section: Introductionmentioning

confidence: 99%

Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery

Bisch¹,

Kooy²,

Glaze³

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

BackgroundTreatment of ovarian cancer often requires extensive surgical resection. The transversus abdominis plane (TAP) block has been utilized in benign gynecologic surgery to decrease post-operative pain and opioid use. We hypothesized that TAP blocks would decrease total opioid use in the first 24 hours and decrease length of stay following staging and cytoreductive surgery for ovarian cancer compared with either no local anesthetic or local wound infiltration alone.MethodsAll patients undergoing surgery for ovarian cancer from November 2016 to June 2017 were included in this retrospective cohort study. Median opioid use at 24, 48, and 72 hours post-operatively, as well as length of stay, were assessed. Multivariate median regression analysis was performed to adjust for potential confounders: post-operative non-steroidal anti-inflammatory drug (NSAID) usage, pre-operative opioid consumption, and extent of cytoreductive surgery. Length of stay was compared using Cox regression analysis.ResultsOne-hundred-and-twenty patients were included in the analysis. Eighty-two patients had a TAP block, while 38 did not. After adjusting for potential confounders there was no difference in median 24 hours opioid consumption (p=0.29) or length of stay (HR 0.95, p=0.78) between patients receiving TAP block compared with those without. After adjusting for potential confounders, patients receiving scheduled NSAIDs had a 2.6-fold greater likelihood of being discharged (p<0.0005) and a significant reduction in median opioid use at 24 hours (23.5 vs 14.5 mg) (p=0.017) compared with those patients without NSAIDs.DiscussionPost-operative administration of NSAIDs, but not TAP block, was associated with a decrease in post-operative opioid use and length of stay following surgery for ovarian cancer. Further investigation into alternative regional anesthetics for Enhanced Recovery after Surgery (ERAS) protocols is warranted.

show abstract

Transversus Abdominis Plane Block for Post Hysterectomy Pain: A Systematic Review and Meta-Analysis

Cited by 52 publications

References 39 publications

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

Enhanced recovery for gynaecological surgery: a review

Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery

Contact Info

Product

Resources

About