Transversus abdominis plane (TAP) block for postoperative pain management after ventral hernia repair: an updated systematic review and meta-analysis.

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-03-12 DOI:10.1007/s10029-025-03305-y

Ana Caroline D Rasador, Carlos A Balthazar da Silveira, Natália P Pereira, Raquel Nogueira, Flavio Malcher, Diego Laurentino Lima

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引用次数: 0

Abstract

Background: Postoperative pain remains a common concern following ventral hernia repair (VHR), especially for open procedures. We aim to assess the effectiveness of the Transversus Abdominis Plane (TAP) block for the management of postoperative pain following VHR.

Methods: Cochrane, EMBASE, and PubMED, MEDLINE, and Web of Science were systematically searched for studies comprising adults undergoing VHR with preoperative TAP block, compared to placebo and epidural analgesia. The outcomes selected for analysis were postoperative pain with the numeric rating scale (NRS), postoperative morphine milligram equivalents (MME) per day, and hospital length of stay (LOS). Subgroup analysis was performed for studies using the Liposomal Bupivacaine (Exparel^®) for TAP block.

Results: 1,460 results were screened, and 14 included, comprising 9 retrospective cohort studies and 5 RCTs, totaling 1,617 patients. TAP block was associated with a shorter LOS compared to conventional pain measures (MD -1,14 days; 95% CI -2.05, -0.22; P = 0.014) and to epidural analgesia (MD -2.02 days; 95% CI -2.67, -1.37; P < 0.001), and lower NRS scale in the day of surgery (MD -1.24; 95% CI -1.81, -0.68; P < 0.001) and in the POD1 (MD -0.63; 95% CI -1.18, -0.08; P = 0.025) compared to placebo. No benefit was seen for TAP block regarding opioid consumption compared to epidural analgesia and placebo. No differences were seen between TAP block and epidural analgesia for the NRS scores. Subgroup analysis of Exparel^® compared to simple bupivacaine showed no benefit for Exparel^®.

Conclusions: The TAP block is associated with shorter LOS compared to placebo and epidural analgesia and is related to less early postoperative pain compared to the conventional pain measures. The TAP block should be considered as a pain management modality for VHR, however cost-effective analysis is required to address the feasibility of the routine utilization of this approach and to balance the financial benefits of its application.

查看原文本刊更多论文

腹疝修补术后疼痛的经腹平面（TAP）阻滞：一项最新的系统综述和荟萃分析。

背景：腹疝修补术（VHR）术后疼痛仍然是一个常见的问题，尤其是开放式手术。我们的目的是评估腹横平面（TAP）阻滞治疗VHR术后疼痛的有效性。方法：系统地检索Cochrane、EMBASE、PubMED、MEDLINE和Web of Science，并与安慰剂和硬膜外镇痛进行比较，这些研究包括术前使用TAP阻滞的成人VHR。选择用于分析的结果是术后疼痛数值评定量表（NRS）、术后每天吗啡毫克当量（MME）和住院时间（LOS）。对使用布比卡因脂质体（Exparel®）阻断TAP的研究进行亚组分析。结果：筛选1460项结果，纳入14项，包括9项回顾性队列研究和5项随机对照试验，共计1617例患者。与常规疼痛措施相比，TAP阻滞与更短的LOS相关(MD -1,14天；95% ci -2.05, -0.22；P = 0.014)和硬膜外镇痛(MD -2.02天；95% ci -2.67, -1.37；P®与单纯布比卡因相比，Exparel®没有任何益处。结论：与安慰剂和硬膜外镇痛相比，TAP阻滞与更短的LOS相关，与常规疼痛措施相比，与更少的术后早期疼痛相关。TAP块应被视为VHR的疼痛管理模式，但需要进行成本效益分析，以解决该方法常规使用的可行性，并平衡其应用的经济效益。

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

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.