Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.016
Brazilian Journal of Anesthesiology
Review Article

Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review

Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome - revisão sistemática

Javier Ripollés; Sandra Marmaña Mezquita; Alfredo Abad; José Calvo

Downloads: 0
Views: 785

Abstract

BACKGROUND:: The transverse abdominal plan blockade is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that were carried out according to the descriptions, and the prospective studies would make it possible to utilize the transverse abdominal plan blockade in different surgical interventions; however, the results obtained in randomized clinical trials are inconsistent.

OBJECTIVES:: To prepare a systematic review aiming to determine the efficacy of the ultrasound-guided transverse abdominal plan blockade for different surgical interventions, as well as the indications according to the approaches and their influences.

METHODS:: Two research approaches, one manual, and the other in Pubmed returned 28 randomized clinical trials where intervention with ultrasound-guided transverse abdominal plan blockades was performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score > 1, according to the inclusion criteria for this review. The authors analyzed independently all the randomized clinical trials.

CONCLUSIONS:: The transverse abdominal plan blockades have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in randomized clinical trial are not conclusive, and as a result, it is necessary to develop new and well designed randomized clinical trial, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

Keywords

TAP block, Transversus abdominis plane, Ultrasound guided, Sistematic review

Resumo

JUSTIFICATIVA:: O bloqueio do plano transverso abdominal (TAP) é um bloqueio da parede abdominal que se difundiu rapidamente na prática clínica como parte de analgesia multimodal em cirurgia abdominal. A técnica ecoguiada permitiu reduzir as possíveis complicações, assim como as novas abordagens, que, de acordo com as descrições feitas e os estudos prospectivos, permitiram usar o TAP em vários procedimentos cirúrgicos; no entanto, os resultados obtidos em ensaios clínicos randomizados (ECR) são inconsistentes.

OBJETIVOS:: Revisão sistemática para determinar a eficácia analgésica do TAP ecoguiado em diversos procedimentos cirúrgicos, assim como determinar as indicações de acordo com abordagens e sua influência.

MÉTODOS:: Foi feita uma pesquisa no PubMed e outra livre, ou manual, e foram encontrados 28 ECR em que uma intervenção com o TAP ecoguiado era feita e se comparava sua eficácia analgésica com outra técnica em humanos adultos, publicados entre 2007 e outubro de 2013 com escore de Jadad > 1, em inglês ou espanhol, de acordo com os critérios de inclusão para esta revisão. Todos os ECR foram analisados de forma independente pelos autores.

CONCLUSÕES:: O TAP mostrou ser uma técnica eficaz em cirurgia colorretal, cesárea, colecistectomia, histerectomia, apendicectomia, nefrectomia em doador, prostatectomia retropúbica e cirurgia bariátrica. No entanto, os dados encontrados nos ECR são inconclusivos, de modo que mais ECR bem desenhados são necessários e com poder estatístico suficiente na comparação de diferentes abordagens, drogas, doses e volumes para uma mesma intervenção, a fim de resolver os temas da atualidade e seu impacto na prática clínica habitual.

Palavras-chave

Bloqueio TAP, Plano transverso do abdome, Ecoguiada, Revisão sistemática

References

Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia.. 2011;56:1024-6.

Hebbard P, Fujiwara Y, Shibata Y. Ultrasound-guided trans- versus abdominis plane (TAP) block. Anaesth Intensive Care.. 2007;35:616-7.

Kearns RJ, Young SJ. Transversus abdominis plane blocks; a nati- onal survey of techniques used by UK obstetric anaesthetists. Int J Obstet Anesth.. 2011;20:103-4.

McDermott G, Korba E, Mata U. Should we stop doing blind transversus abdominis plane blocks?. Br J Anaesth.. 2012;108:499-502.

Jankovic Z, Ahmad N, Ravishankar N. Transversus abdomi- nis plane block: how safe is it?. Anesth Analg.. 2012;107:1758-9.

Farooq M, Carey M. A case of liver trauma with a blunt regio- nal anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med.. 2008;33:274-5.

Blanco R. TAP block under ultrasound guidance: the description of a "no pops trechnique". Reg Anaesth Pain Med.. 2007;32 Suppl 1:130.

Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg.. 2011;106:674-7675.

Borglum J, Maschmann C, Belhage B. Ultrasound-guided bilateral dual transversus abdominis plane block: a new four-point approach. Acta Anaesthesiol Scand.. 2011;55:658-63.

Neal JM, Brull R, Chan VWS. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary. Reg Anesth Pain Med.. 2010;35 2 Suppl:S1-9.

Abrahams MS, Horn J-L, Noles LM. Evidence-based medicine: ultrasound guidance for truncal blocks. Reg Anesth Pain Med.. 2010;35 2 Suppl:S36-42.

McDonnell JG, O'Donnell BD, Farrell T. Transversus abdo- minis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med.. 2007;32:399-404.

Tran TMN, Ivanusic JJ, Hebbard P. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth.. 2009;102:123-7.

Lee THW, Barrington MJ, Tran TMN. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care.. 2010;38:452-60.

Carney J, Finnerty O, Rauf J. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Ana- esthesia.. 2011;66:1023-30.

McDonnell JG, Finnerty O, Laffey JG. Stellate ganglion bloc- kade for analgesia following upper limb surgery. Anaesthesia.. 2011;66:611-4.

Niraj G, Kelkar A, Jeyapalan I. Comparison of analge- sic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Ana- esthesia.. 2011;66:465-71.

Walter CJ, Maxwell-Armstrong C, Pinkney TD. A ran- domised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colo- rectal surgery. Surg Endosc.. 2013;27:2366-72.

Belavy D, Cowlishaw PJ, Howes M. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth.. 2009;103:726-30.

Costello JF, Moore AR, Wieczorek PM. The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Reg Anesth Pain Med.. 2009;34:586-9.

Baaj JM, Alsatli RA, Majaj HA. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for post- cesarean section delivery analgesia-a double-blind, placebo-controlled, randomized study. Middle East J Anesthesiol.. 2010;20:821-6.

Kanazi GE, Aouad MT, Abdallah FW. The analge- sic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg.. 2010;111:475-81.

Loane H, Preston R, Douglas MJ. A randomized controlled trial comparing intrathecal morphine with transversus abdomi- nis plane block for post-cesarean delivery analgesia. Int J Obstet Anesth.. 2012;21:112-8.

Tan TT, Teoh WHL, Woo DCM. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol.. 2012;29:88-94.

Bollag L, Richebe P, Siaulys M. Effect of transversus abdo- minis plane block with and without clonidine on post-cesarean delivery wound hyperalgesia and pain. Reg Anesth Pain Med.. 2012;37:508-14.

Eslamian L, Jalili Z, Jamal A. Transversus abdominis plane block reduces postoperative pain intensity and analge- sic consumption in elective cesarean delivery under general anesthesia. J Anesth.. 2012;26:334-8.

Cánovas L, López C, Castro M. Contribution to post-caesarean analgesia of ultrasound-guided transversus abdomi- nis plane block. Rev Esp Anestesiol Reanim.. 2003;60:124-8.

Lee AJ, Palte HD, Chehade JMA. Ultrasound-guided bila- teral transversus abdominis plane blocks in conjunction with intrathecal morphine for postcesarean analgesia. J Clin Anesth.. 2013;25:475-82.

El-Dawlatly AA, Turkistani A, Kettner SC. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth.. 2009;102:763-7.

Ra YS, Kim CH, Lee GY. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean J Anesthesiol.. 2010;58:362-8.

Petersen PL, Stjernholm P, Kristiansen VB. The beneficial effect of transversus abdominis plane block after laparosco- pic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg.. 2012;115:527-33.

Ortiz J, Suliburk JW, Wu K. Bilateral transversus abdominis plane block does not decrease postoperative pain after laparos- copic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med.. 2012;37:188-92.

Tolchard S, Martindale S, Davies R. Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecys- tectomy: comparison with conventional port-site infiltration. J Anaesthesiol Clin Pharmacol.. 2012;28:339.

Griffiths JD, Middle JV, Barron FA. Transversus abdominis plane block does not provide additional benefit to multimo- dal analgesia in gynecological cancer surgery. Anesth Analg.. 2010;111:797-801.

Atim A, Bilgin F, Kilickaya O. The efficacy of ultrasound-guided transversus abdominis plane block in patients under- going hysterectomy. Anaesth Intensive Care.. 2011;39:630-4.

De Oliveira GS Jr, Fitzgerald PC, Marcus R-J. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg.. 2011;113:1218-25.

Kane SM, Garcia-Tomas V, Alejandro-Rodriguez M. Ran- domized trial of transversus abdominis plane block at total laparoscopic hysterectomy: effect of regional analgesia on qua- lity of recovery. Am J Obstet Gynecol.. 2012;207:419, e1-5.

Aveline C, le Hetet H, le Roux A. Comparison between ultrasound-guided transversus abdominis plane and conventio- nal ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth.. 2011;106:380-6.

López González JM, Jiménez Gómez BM, Areán González I. Bloqueo transverso abdominal ecoguiado vs infiltración de herida quirúrgica en cirugía ambulatoria de hernia inguinal.. Cir May Amb.. 2013;18:7-11.

Petersen PL, Mathiesen O, Stjernholm P. The effect of transversus abdominis plane block or local anaesthetic infiltra- tion in inguinal hernia repair: a randomised clinical trial. Eur J Anaestthesiol.. 2013;30:415-21.

Niraj G, Searle A, Mathews M. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth.. 2009;103:601-5.

Hosgood SA, Thiyagarajan UM, Nicholson HFL. Randomi- zed clinical trial of transversus abdominis plane block versus placebo control in live-donor nephrectomy. Transplantation.. 2012;94:520-5.

Parikh BK, Waghmare VT, Shah VR. The analgesic effi- cacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized con- trolled study. Saudi J Anaesth.. 2013;7:43-7.

Sinha A, Jayaraman L, Punhani D. Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obes Surg.. 2013;23:548-53.

Albrecht E, Kirkham KR, Endersby RVW. Ultrasound-guided transversus abdominis plane (TAP) block for laparoscopic gastric-bypass surgery: a prospective randomized controlled double-blinded trial. Obes Surg.. 2013;23:1309-14.

Wu Y, Liu F, Tang H. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epi- dural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg.. 2013;17:507-13.

Elkassabany N, Ahmed M, Malkowicz SB. Comparison between the analgesic efficacy of transversus abdominis plane (TAP) block and placebo in open retropubic radical prostatec- tomy: a prospective, randomized, double-blinded study. J Clin Anesth.. 2013;25:459-65.

Milan ZB, Duncan B, Rewari V. Subcostal transversus abdo- minis plane block for postoperative analgesia in liver transplant recipients. Transplant Proc.. 2011;43:2687-90.

Skjelsager A, Ruhnau B, Kistorp TK. Transversus abdomi- nis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study. Acta Anaesthesiol Scand.. 2013;57:502-8.

Urrútia G, Bonfill X. PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses. Med Clin (Barc).. 2010;135:507-11.

Petersen PL, Mathiesen O, Torup H. The transversus abdominis plane block: a valuable option for postopera- tive analgesia? A topical review. Acta Anaesthesiol Scand.. 2010;54:529-35.

Sharkey A, Finnerty O, McDonnell JG. Role of transversus abdominis plane block after caesarean delivery. Curr Opin Ana- esthesiol.. 2013;26:268-72.

Zeisler JA, Gaarder TD, de Mesquita SA. Lidocaine excretion in breast milk. Drug Intell Clin Pharm.. 1986;20:691-3.

Ito S, Lee A. Drug excretion into breast milk-overview. Adv Drug Deliv Rev.. 2003;55:617-27.

Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials.. 1996;17:1-12.

Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after cesarean delivery: a systematic review and meta-analysis. Can J Anaesth.. 2012;59:766-78.

Nordin P, Zetterstrom H, Carlsson P. Cost-effectiveness analysis of local, regional and general anaesthesia for inguinal hernia repair using data from a randomized clinical trial. Br J Surg.. 2007;94:500-5.

Brady RR, Ventham NT, Roberts DM. Open transversus abdominis plane block and analgesic requirements in pati- ents following right hemicolectomy. Ann R Coll Surg Engl.. 2012;94:327-30.

Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block. Reg Anesth Pain Med.. 2012;37:193-209.

Griffiths JD, Barron FA, Grant S. Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block. Br J Anaesth.. 2010;105:853-6.

5dd297ee0e88251739c63493 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections