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Opioid-Sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-Analysis.

Posthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regimen combined with transversus abdominis plane (TAP) block. We searched PubMed, EMBASE, and Cochrane Database for randomized co...

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Published in:AANA Journal Vol. 86; no. 1; pp. 41 - 56
Main Author: Tubog, Tito D.
Format: meta analysis research systematic review tables/charts Journal Article
Published: American Association of Nurse Anesthetists Feb2018
Online Access:View this record in EBSCOhost
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      dt: Feb2018
      vid: 86
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      pub: American Association of Nurse Anesthetists
      place: Park Ridge, Illinois
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        atl: Opioid-Sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-Analysis.
      aug:
        au: Tubog, Tito D.
        affil: Certified Registered Nurse Anesthetist and associate director, Clinical Education, at Texas Wesleyan University
      sug:
        subj:
          Analgesics, Opioid
          Transversus Abdominis Anatomy and Histology
          Nerve Block
          Hysterectomy
          Human
          Systematic Review
          Meta Analysis
          Databases
          Female
          Postoperative Complications
          Pain Management
          PubMed
          Embase
          Cochrane Library
          Morphine Administration and Dosage
          Population
          Female
      ab: Posthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regimen combined with transversus abdominis plane (TAP) block. We searched PubMed, EMBASE, and Cochrane Database for randomized controlled trials evaluating the opioid-sparing effects of TAP block in patients undergoing hysterectomy. The primary outcome was morphine consumption in the perioperative phase extending to 48 hours after surgery. The secondary outcomes were pain scores at rest and during coughing, time of first postoperative analgesia, and incidence of postoperative nausea and vomiting (PONV) and sedation. Twenty-three trials were selected consisting of 1,554 patients. Morphine consumption showed a reduction of 3.6 mg intraoperatively (mean difference [MD], -3.57; 95% CI, -6.88 to -0.25); 2.9 mg in the recovery room (MD, -2.86; 95% CI, -5.55 to -0.15); 3.4 mg at 24 hours (MD, -3.43; 95% CI, -6.77 to -0.09), and 29 mg at 48 hours (MD, -28.68; 95% CI, -44.35 to -13.01) after surgery in favor of TAP block. Pain scores were lower at rest, and the incidence of PONV and sedation were reduced. Although opioid-sparing effects of TAP block were significant perioperatively, its clinical application is debatable because of substantial heterogeneity across studies.
      pubtype: Academic Journal
      doctype:
        meta analysis
        research
        systematic review
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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