Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic surgeries: A systematic review and meta-analysis

Background: Efficient pain management modalities are the armamentarium of the Enhanced Recovery Surgery protocol. Transversus abdominis plane (TAP) block is one such measure and has mixed findings regarding its effectiveness. Hence, this systematic review and meta-analysis aimed to assess the effectiveness of laparoscopic-assisted (LAP) TAP block versus USG-TAP block on pain management and opioid consumption. Methods: We searched PubMed, Scopus, EMBASE and the Cochrane Register of controlled trials to identify eligible RCTs. Two authors screened, selected studies, and extracted data independently. Quality was assessed by two authors using the Cochrane risk of bias assessment tool. Heterogeneity and publication biases were assessed using the I2-statistic and Egger's test respectively. The random effect method was used to synthesize weighted/standardized mean differences. Results: A total of 8 RCTs were found eligible out of 424 unique records. Weighted mean difference between LAP and USG blocks in pain intensity measured on VAS scale are-0.23(-1.10,0.64), -0.14(0.69,0.41) and 0.04(-0.18,0.26) at 6, 24 and 48 h respectively. Intraoperative and postoperative standardized mean difference in opioaid consumption was 0.24(0.00,0.47) and-0.20(-0.63,0.23) respectively. Conclusion: Our results based on a few small-scale RCTs show that the pain management and opioid consumption were similar in laparoscopic or USG guided TAP blocks. (C) 2022 Elsevier Ltd. All rights reserved.