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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(01): 055-066
DOI: 10.1055/s-0041-1740595
Review Article

Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis

Eficácia do bloqueio transverso do plano abdominal na redução da dor e da necessidade de opioides em histerectomia laparoscópica e assistida por robô: Uma revisão sistemática e metanálise
Claudia López-Ruiz 
1   Department of Gynecology and Obstetrics, Clínica del Prado, Medellín, Colombia
2   School of Graduate Studies, School of Medicine, CES University, Medellín, Colombia
,
Jerutsa Catalina Orjuela 
1   Department of Gynecology and Obstetrics, Clínica del Prado, Medellín, Colombia
,
Diego Fernando Rojas-Gualdrón 
2   School of Graduate Studies, School of Medicine, CES University, Medellín, Colombia
,
Marcela Jimenez-Arango 
2   School of Graduate Studies, School of Medicine, CES University, Medellín, Colombia
,
José Fernando de los Ríos 
1   Department of Gynecology and Obstetrics, Clínica del Prado, Medellín, Colombia
,
Elsa Maria Vásquez-Trespalacios 
2   School of Graduate Studies, School of Medicine, CES University, Medellín, Colombia
,
Claudia Vargas 
3   American Association of Gynecologic Laparoscopists, Medellín, Colombia
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Abstract

Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy.

Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy.

Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles.

Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87–0.46) in pain scale scores (I2 = 68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43–0.44; I2 = 69%); opioid requirement: DM 0.36 (95%CI: - 0.94–1.68; I2 = 80%); and incidence of nausea and vomiting with a difference of 95%CI = - 0.11 (- 0.215–0.006) in favor of TAP.

Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores.

Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.

Resumo

Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica.

Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô.

Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados.

Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nas médias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87–0 46) nos escores da escala de dor (I2 = 68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043–044; I2 = 69%); necessidade de opioides: DM 0 36 (95%CI: - 0 94–168; I2 = 80%); e incidência de náuseas e vômitos com diferença de 95% CI = - 011 (- 0215–0006) a favor do TAP.

Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pós-operatória inicial.

Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.

Keywords

transversus abdominis plane block - pain - laparoscopic hysterectomy - robotic-assisted hysterectomy - opioid

Palavras-chave

bloqueio do plano transverso do abdome - dor - histerectomia laparoscópica - histerectomia robótica assistida - opioide


Publication History

Received: 05 March 2021

Accepted: 30 August 2021

Article published online:
29 January 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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