///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Meta-analysis of the Efficacy of Transversus Abdominis Plane Block after Abdominal Surgery

Abstract Number: 79
Abstract Type: Meta Analysis/Review of the Literature

Harold Gelfand MD1 ; Jamie D Murphy MD2; Fay A Horng MD3; Gillian Isaac MD, PhD4; Cristianna Vallera MD5; Christopher Wu MD6

Objective: Transversus abdominis plane (TAP) block has been advocated as a means for providing analgesia after abdominal surgery including Cesarean section. However, the overall analgesic efficacy of TAP blocks is unclear. We have performed a meta-analysis to further examine this issue.

Method: This study qualified for exemption from the Johns Hopkins IRB. Systematic literature searches of the National Library of Medicines PubMed and EMBASE databases were conducted using terms related to transversus abdominis plane blocks. Only randomized controlled trials comparing TAP block with local anesthetic to control (either saline block or no block) were included for analysis. Data on pertinent study characteristics and relevant outcomes were extracted from accepted articles. There was no restriction on language for inclusion. Meta-analysis was performed using the Review Manager 4.2.10 (The Cochrane Collaboration, 2004). A random effects model was used.

Results: The literature searches yielded 110 abstracts of which 7 met all inclusion criteria. There were a total of 185 subjects for the TAP block group and 188 for the control group. We were able to obtain pooled estimates for VAS pain at 12 hours (all procedures), VAS pain at 24 hours (Cesarean section only), postoperative nausea and vomiting (all procedures), and sedation (all procedures). We were unable to obtain pooled estimate for other parameters (VAS pain at 6 and 24 hours for all procedures, VAS pain at 24 hours for Cesarean section, morphine consumption at 24 hours) due to excessive heterogeneity. We found no significant differences in any of the pooled estimates for VAS pain at 12 hours (all procedures) [weighted mean differences (WMD): -0.63 (-1.31, 0.05)], VAS pain at 24 hours (Cesarean section only) [WMD: -0.33 (-1.00, 0.35)], postoperative nausea and vomiting (all procedures) [Odds ratio (OR): 0.35 (0.11, 1.14)], and sedation (all procedures) [OR: 0.37 (0.08, 1.80)].

Conclusions: Our pooled analysis examining the analgesic efficacy of TAP block for abdominal surgery did not reveal any differences (versus control) with regard to VAS pain at 12 hours (all procedures), VAS pain at 24 hours (Cesarean section only), postoperative nausea and vomiting (all procedures), and sedation (all procedures). The "negative" results should be interpreted with caution and certainly further examination with larger RCT is warranted as the overall number of subjects is relatively small.

SOAP 2010