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

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.

摘要
研究目的：系统总结腹横肌平面阻滞（Transversus Abdominis Plane Block, TAP Block）用于腹腔镜或机器人辅助子宫切除术的疗效相关现有证据。
数据来源：我们检索了相关数据库及灰色文献，纳入对比腹横肌平面阻滞与安慰剂或无干预措施用于接受腹腔镜或机器人辅助子宫切除术患者的随机对照试验。
研究筛选方法：由两名研究者独立评估入选文献的合格性。
结果汇总与整合：共纳入7项研究，涉及518例患者。术后早期疼痛方面，疼痛评分的均数差（MD）为-1.17（95%置信区间[CI]：-1.87~0.46），I²=68%，结果具有统计学意义，支持使用TAP阻滞，但无临床相关性；术后晚期疼痛的均数差为0.001（95%CI：-0.43~0.44；I²=69%）；阿片类药物使用需求量的均数差为0.36（95%CI：-0.94~1.68；I²=80%）；恶心呕吐发生率的均数差为-0.11（95%CI：-0.215~0.006），结果同样支持TAP阻滞。
结论：尽管术后早期疼痛评分存在统计学意义，但由于各研究间异质性较高且基线特征存在不均衡，现有证据强度中等，结果提示腹横肌平面阻滞不应被视为可改善腹腔镜或机器人辅助子宫切除术后疼痛的具有临床相关性的镇痛技术。
临床试验注册号及注册平台：PROSPERO编号 - CRD42018103573。