Transversus abdominis plane block in adult open liver surgery patients: A systematic review with meta-analysis of randomized controlled trials

• Published in: Journal of visceral surgery 2023-08, Vol.160 (4), p.253-260
• Main Authors: Abdildin, Y., Tapinova, K., Nugumanova, M., Viderman, D.
• Format: Article
• Language: English
• Subjects: Liver oncology; Open liver surgery; Opioid consumption; Pain control; Postoperative pain; Transversus abdominis plane block
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2022.11.003

•Regional blocks promise to be an adequate alternative to traditional epidural anesthesia in open liver surgery patients.•Transversus abdominis plane block (TAPB) seems to decrease time to flatus in open liver surgery patients.•TAPB decreased pain at rest at 24hours after open liver surgery, but it was not clinically significant.•TAPB does not improve opioid use, side effects, or length of hospital stay in open liver surgery patients. The objective of this meta-analysis is to evaluate the efficacy of Transversus Abdominis Plane Block (TAPB) in pain control and recovery after open hepatic surgery. We searched for the articles in PubMed, Google Scholar, and the Cochrane Library published before March 2022. We included randomized controlled trials (RCTs) comparing TAPB with a placebo in adult patients after open liver surgery. Meta-analysis was conducted in RevMan 5.4. Methodological quality was assessed via the Jadad/Oxford scale and Cochrane Risk of Bias tool. Five RCTs with 347 patients were included. All studies had an acceptable Jadad score or higher. For pain at rest at 24hours postoperatively, the standardized mean difference (SMD) with a 95% confidence interval (CI) was −1.08 [−1.97, −0.18], P-value 0.02, favoring TAPB. Models for total opioid consumption, nausea and vomiting, and duration of hospital stay did not demonstrate a difference between the groups. The model for time to first flatus favored TAPB with SMD with a 95% CI of −1.48 [−2.72, −0.24], P-value 0.02. Our meta-analysis of five RCTs favored TAPB regarding pain control at rest and time to first flatus. Due to the small sample size and considerable heterogeneity, more RCTs are needed. CRD42022320565.