Ultrasound-guided versus laparoscopic-guided transversus abdominus plane block for laparoscopic cholecystectomy - A systematic review and meta-analysis of randomised clinical trials.

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland Pub Date : 2025-06-03 DOI:10.1016/j.surge.2025.05.003

Matthew G Davey, Gordon R Daly, Noel E Donlon, Nuala A Healy, Arnold D K Hill

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引用次数: 0

Abstract

Background: The use of transversus abdominus plane (TAP) blocks have come into vogue in recent times, with the ambition to reduce post-operative pain following laparoscopic cholecystectomy. TAP block is commonly performed using an ultrasound-guided approach (US-TAP), with emerging data indicating that laparoscopic-guided (L-TAP) approach may also be useful.

Aim: To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) comparing outcomes following US-TAP and L-TAP block in patients undergoing laparoscopic cholecystectomy.

Methods: A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4.

Results: 6 RCTs including 428 patients were included. Overall, 212 patients were randomised to US-TAP (49.5 %) and 216 to L-TAP (50.5 %) respectively. A non-significant difference was observed between groups for mean age, gender, mean body mass indices, and American Society of Anesthesiologists grades (all P > 0.050). At meta-analyses, a non-significant difference was observed for US-TAP and L-TAP with respect to 2-, 6-, 12-, 24-, and 48-h post-operative visual analogue scores. A non-significant difference was also observed in relation to intraoperative duration, breakthrough opioid consumption, and post-operative vomiting, at meta-analysis. Patients who underwent US-TAP had longer anesthetic administration times (mean difference: 6.38, 95 % confidence interval: 2.77-10.00, P < 0.001) compared to those randomised to undergo L-TAP.

Conclusion: L-TAP and US-TAP provided similar post-operative pain scores, intraoperative duration, breakthrough opioid consumption, and post-operative vomiting following laparoscopic cholecystectomy. However, the time taken to perform L-TAP was significantly shorter. Should expertise allow, L-TAP should be considered in patients undergoing laparoscopic cholecystectomy.

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超声引导与腹腔镜引导下经腹平面阻滞用于腹腔镜胆囊切除术-随机临床试验的系统回顾和荟萃分析。

背景：近年来，为了减少腹腔镜胆囊切除术后的疼痛，使用腹横平面（TAP）阻滞已成为一种时尚。TAP阻滞通常使用超声引导入路（US-TAP）进行，新出现的数据表明腹腔镜引导（L-TAP）入路也可能有用。目的：对随机临床试验（rct）进行系统回顾和荟萃分析，比较腹腔镜胆囊切除术患者采用US-TAP和L-TAP阻断治疗的结果。方法：按照PRISMA指南进行系统评价。meta分析使用Review Manager版本5.4进行。结果：共纳入6项rct，共纳入428例患者。总体而言，212名患者随机分配到US-TAP组（49.5%）和216名患者随机分配到L-TAP组（50.5%）。各组间的平均年龄、性别、平均体重指数和美国麻醉医师学会评分差异无统计学意义（P均为0.050）。在荟萃分析中，US-TAP和L-TAP在术后2、6、12、24和48小时的视觉模拟评分方面无显著差异。在荟萃分析中，也观察到术中持续时间、突破性阿片类药物消耗和术后呕吐方面的无显著差异。采用US-TAP的患者麻醉时间更长（平均差异：6.38,95%可信区间：2.77-10.00，P）。结论：L-TAP和US-TAP在腹腔镜胆囊切除术后的术后疼痛评分、术中持续时间、突破性阿片类药物消耗和术后呕吐方面具有相似的差异。然而，执行L-TAP所需的时间明显缩短。在专业知识允许的情况下，腹腔镜胆囊切除术患者应考虑L-TAP。

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

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 医学-外科

CiteScore

4.40

自引率

0.00%

发文量

158

审稿时长

6-12 weeks

期刊介绍： Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field. Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.