Transversus Abdominis Plane Block to Alleviate Postoperative Pain in Children: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Transversus abdominis plane (TAP) block has been applied as one of multimodal approaches to alleviate postoperative pain in children. The aim of this meta-analysis was to determine the effect of TAP block on postoperative pain management for children who underwent surgery. Methods: The randomized controlled trials (RCTs) which evaluated the analgesia effect of TAP block in children who underwent surgery were searched on the databases of Medline, Embase, the Cochrane Controlled Trials Register and Google Scholar. The RCTs which compared the analgesic effect of TAP block group with control group (placebo or "no treatment") in children were included. Postoperative opioid consumption (48 hours) was considered as the primary outcomes. The secondary outcomes included the number of children needed postoperative opioid analgesia rescue, the time to first analgesic administration (hours) and pain score. The risk ratios (RR), weighted mean differences (WMDs), and their corresponding 95% con fi dence intervals (95% CIs) were calculated for both dichotomous and continuous outcomes. Results: Five RCT trials with 257 children met our criteria and were included in the analysis. Compared with the control group, TAP block reduced the 48 hours morphine consumption by 0.03 mg/kg (95% CI -0.05 to -0.00, P=0.03, 159 children in 3 RCTs). Besides, the non-signi fi cant reductions were shown in the number of children needed postoperative opioid analgesia rescue (217 children in 4 RCTs) and time to first analgesic administration (hours, 184 children in 3 RCTs). Conclusions: TAP block is one of the safe and effective multimodal-approaches to alleviate postoperative pain in children. Specially, when the TAP block was used, it can significantly reduce the opioid consumption, which may avoid the occurrence of dose-dependent side effects of opioid drugs.