Transversus abdominis plane block for postoperative pain management and opioid sparing: a systematic review and...

The transversus abdominis plane (TAP) block is a regional anaesthetic technique targeting thoracolumbar sensory nerve afferents to provide analgesia to the anterolateral abdominal wall. With emerging RCTs supporting its efficacy across various surgeries, an updated, comprehensive review is warranted to assess its analgesic effectiveness and opioid sparing potential.

A systematic review and meta-analysis were conducted to assess the analgesic efficacy of the TAP block. We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to May 2024. We included RCTs that compared the TAP block with placebo, local infiltration, epidural analgesia, or intrathecal morphine and reported 6-, 12-, or 24-h postoperative pain scores or cumulative 24-h postoperative morphine consumption. Meta-analyses were performed for all outcomes.

A total of 123 RCTs were included in this review. The TAP block group showed significant reductions across all outcomes when compared with placebo. When compared with local infiltration, the TAP block also showed significant reductions in 6-h (standardised mean difference [SMD]=-0.89; 95% confidence interval [95% CI], -1.35 to -0.43; P<0.001), 12-h (SMD=-1.27; 95% CI, -2.08 to -0.46; P=0.002), and 24-h (SMD=-0.66; 95% CI, -1.01 to -0.32; P<0.001) postoperative pain, and in cumulative 24-h postoperative morphine consumption (SMD=-0.99; 95% CI, -1.52 to -0.47; P<0.001). However, it only showed a reduction in 12-h pain scores when compared with epidural analgesia and did not differ significantly with intrathecal morphine for any of the outcomes.

The TAP block is an effective anaesthetic modality for pain management and opioid sparing after abdominal surgery.

PROSPERO (CRD42024374067).