Laparoscopic-assisted versus ultrasound-guided transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis.

IF 1.6 3区 医学 Q2 SURGERY
Sundus Abdul Ghani, Hassan Ul Hussain, Maryam Abdul Wahid, Neha Majeed, Sheeba Burney, Areesha Tanveer, Muhammad Sohaib Asghar
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引用次数: 0

Abstract

Background: Laparoscopic-assisted (LTAP) and ultrasound-guided (UTAP) transversus abdominis plane (TAP) blocks are widely used for postoperative analgesia in laparoscopic cholecystectomy (LC), yet their comparative effectiveness remains unclear. The aim of this meta-analysis was to systematically evaluate and compare postoperative outcomes of LTAP and UTAP in LC.

Materials and methodology: A comprehensive literature search of five electronic databases was conducted from the inception of the paper till 2 June 2024 following PRISMA guidelines. Eligibility criteria included: (a) randomized controlled trials (RCTs); (b) adult patients (≥ 18 years) undergoing elective LC; (c) intervention group undergoing LTAP; (d) control group receiving UTAP; (e) outcomes: postoperative pain intensity using VAS score; time to first analgesic need; postoperative morphine consumption; postoperative nausea vomiting (PONV); time to first bowel evacuation; time to first flatus. Mendeley Desktop 1.19.8 was used for article retrieval and for the removal of duplicates. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and statistical analysis was performed using Review Manager, applying a random-effects model. Forest plots represented combined effects of Risk Ratios (RRs) for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes with a 95% confidence interval (CI). P-value ≤ 0.05 was considered statistically significant and Higgin's I² test was employed to assess heterogeneity.

Results: Seven RCTs in total involving 603 patients were included in the analysis, with 236 patients in the LTAP group and 232 in the UTAP group. No statistically significant differences observed between LTAP and UTAP in postoperative pain intensity at 6, 12, and 24 h, time to first analgesic need, postoperative morphine consumption, PONV, time to first stools, and time to first flatus, initially. Sensitivity analysis revealed a significant reduction in 6-hour postoperative pain in the LTAP group (WMD = 0.39; 95% CI = 0.10,0.67; P = 0.008; I² = 0%), but no significant differences were found in later time points (12 h: WMD = 0.12; 95% CI = -0.17,0.40; P = 0.42; I² = 0%; 24 h: WMD = -0.04; 95% CI = -0.26, 0.18; P = 0.73; I² = 5%) or in other outcomes. Moderate levels of heterogeneity and an overall low risk of bias in quality assessment were observed among the studies.

Conclusion: Our meta-analysis indicated no clear advantage of LTAP over UTAP in managing postoperative pain and related outcomes in LC. Although LTAP may offer logistical benefits by reducing the need for equipment and personnel, further large-scale RCTs focusing on procedure-specific outcomes are needed to establish definitive conclusions.

腹腔镜胆囊切除术中腹腔镜辅助与超声引导的经腹平面阻滞:系统回顾和荟萃分析。
背景:腹腔镜辅助(LTAP)和超声引导(UTAP)经腹平面(TAP)阻滞广泛应用于腹腔镜胆囊切除术(LC)术后镇痛,但其比较效果尚不清楚。本荟萃分析的目的是系统评价和比较LTAP和UTAP在LC中的术后结果。材料和方法:根据PRISMA指南,从论文开始到2024年6月2日,对五个电子数据库进行了全面的文献检索。入选标准包括:(a)随机对照试验(RCTs);(b)接受选择性LC的成年患者(≥18岁);(c)接受LTAP的干预组;(d)对照组接受UTAP;(e)结局:术后疼痛强度(VAS评分);第一次止痛需要的时间;术后吗啡用量;术后恶心呕吐(PONV);第一次排便时间;第一次放屁的时间到了。使用Mendeley Desktop 1.19.8进行文章检索和重复删除。使用Cochrane风险偏倚工具评估偏倚风险,使用Review Manager应用随机效应模型进行统计分析。森林图表示二分结局的风险比(rr)和连续结局的加权平均差异(wmd)的综合效应,置信区间为95%。p值≤0.05为差异有统计学意义,采用Higgin’s I²检验评估异质性。结果:共纳入7项rct,共603例患者,其中LTAP组236例,UTAP组232例。LTAP与UTAP在术后6、12、24小时疼痛强度、首次镇痛时间、术后吗啡用量、PONV、首次便时间、首次放屁时间等方面均无统计学差异。敏感性分析显示,LTAP组术后6小时疼痛显著减轻(WMD = 0.39;95% ci = 0.10,0.67;p = 0.008;I²= 0%),但在随后的时间点无显著差异(12 h: WMD = 0.12;95% ci = -0.17,0.40;p = 0.42;I²= 0%;24小时:WMD = -0.04;95% ci = -0.26, 0.18;p = 0.73;I²= 5%)或其他结果。在这些研究中观察到中等程度的异质性和总体低的质量评估偏倚风险。结论:我们的荟萃分析显示LTAP在控制LC术后疼痛和相关结果方面没有明显优于UTAP。尽管LTAP可以通过减少对设备和人员的需求来提供后勤方面的好处,但需要进一步大规模的随机对照试验,重点关注特定手术的结果,以确定明确的结论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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