Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis

Hamid HK, Emile SH, Saber AA, Ruiz-Tovar J, Minas V, Cataldo TE

Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis

J Am Coll Surg. 2020 Sep;231(3):376-386.e15. doi: 10.1016/j.jamcollsurg.2020.05.020. Epub 2020 Jun 2.

What is already known:

Optimal multimodal analgesia constitutes one of the ERAS interventions, but the evidence base in favor for one optimal analgesic regimen compared to another is currently weak. Transversus abdominus plane (TAP) block has recently been shown to reduce post-operative pain and opioid consumption resulting in enhanced mobilization after surgery.

A TAP block is performed by injecting local anesthetics into the nervous plane in between the transverse and external muscles in the abdominal wall, thereby blocking the nerves responsible for transmitting pain from the laparoscopic incisions during surgery. This has traditionally been performed by an anesthesiologist using ultrasound (ULTAP) to guide the needle for injection into the right plane of the abdominal wall, but this procedure can be cumbersome and time consuming and can cause a prolonged duration of anesthesia for patients.

Therefore, a novel laparoscopic technique without the use of ultrasound has been described (LAPTAP) which can be performed by the surgeon during the operation and may shorten anesthesia since the method requires less elaborate preparation.

Th current meta-analysis compares the efficacy of the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (LATAP) with other analgesic alternatives in adults undergoing minimally invasive surgery.

What this paper adds:

After a systematic literature search for randomized controlled trials (RCTs) reporting on LAPTAP, 19 RCTs with 1,983 patients were included. Primary outcomes were pain scores at rest and movement at 24 hours postoperatively. All trials compared LATAP with ULTAP, local infiltration analgesia (LIA), or inactive control. LAPTAP provided equal pain control compared with ULTAP, and better early pain control compared with local infiltration analgesia. Recovery parameters, 24-hour opioid consumption, and postoperative nausea and vomiting (PONV) were equal between LAPTAP and ULTAP. The authors conclude that LAPTAP can be used as a safer and pragmatic alternative to epidural analgesia in laparoscopic or robotic abdominal procedures.

Additional comment:

In many centers, TAP is currently a standard procedure within multimodal analgesia in minimal invasive abdominal surgery. However, although the technique is suitable in many patients, additional treatment with other modalities is often necessary. Further research on an optimal postoperative analgesia regimen is warranted.