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Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
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Abstract

Background

The efficacy of transversus abdominis plane (TAP) block compared with thoracic epidural analgesia (TEA) in abdominal surgery has been controversial. We conducted this systematic review and meta-analysis to assess outcomes of TAP block and TEA in a procedure-specific manner in colorectal surgery.

Methods

A systematic literature search of the PubMed, Embase, Cochrane Library, and Scopus databases was conducted through July 10, 2020, to identify randomized controlled trials (RCTs) comparing TAP block with TEA in colorectal surgery. Primary outcomes were pain scores at rest and movement at 24 h postoperatively. Secondary outcomes included postoperative pain scores at 0–2 and 48 h, opioid consumption, postoperative nausea and vomiting (PONV), functional recovery, hospital stay, and adverse events.

Results

Six RCTs with 568 patients were included. Methodological quality of these RCTs ranged from moderate to high. TAP block provided comparable pain control, lower 24 h and total opioid consumption, shorter time to ambulation and urinary catheter time, and lower incidence of sensory disturbance and postoperative hypotension compared with TEA. Meanwhile, the 48-h opioid consumption, PONV incidence, and hospital stay were similar between groups. When laparoscopic surgery was the only surgical approach employed, TAP block provided additional benefits of shorter time to first flatus and lower incidence of PONV compared with TEA.

Conclusions

Perhaps more germane to minimally invasive procedures, TAP block is equivalent to TEA in terms of postoperative pain control and provides better functional recovery with lower incidence of adverse events in patients undergoing colorectal surgery.

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Author information

Authors and Affiliations

  1. Department of Surgery, Soba University Hospital, Khartoum, Sudan

    Hytham K. S. Hamid

  2. Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain

    Artur Marc-Hernández

  3. Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA

    Alan A. Saber

Authors
  1. Hytham K. S. Hamid
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  2. Artur Marc-Hernández
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  3. Alan A. Saber
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hytham Hamid, Artur Hernandez, and Alan Saber. The first draft of the manuscript was written by Hytham Hamid and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hytham K. S. Hamid.

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Hamid, H.K.S., Marc-Hernández, A. & Saber, A.A. Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 406, 273–282 (2021). https://doi.org/10.1007/s00423-020-01995-9

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  • DOI: https://doi.org/10.1007/s00423-020-01995-9

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