BACKGROUND This review and meta-analysis aims to evaluate the analgesic efficacy of continuous transversus abdominis plane (TAP) block compared with epidural analgesia (EA) in adults after abdominal surgery. METHODS The databases PubMed, Embase and Cochrane Central Register were searched from inception to June 2019 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy of continuous TAP block compared with EA after abdominal surgery. The weighted mean differences (WMDs) were estimates for continuous variables with a 95% confidence interval (CI) and risk ratio (RR) for dichotomous data. The pre-specified primary outcome was the dynamic pain scores 24 h postoperatively. RESULTS Eight trials including 453 patients (TAP block:224 patients; EA: 229 patients) ultimately met the inclusion criteria and seven trials were included in the meta-analysis. Dynamic pain scores after 24 h were equivalent between TAP block and EA groups (WMD:0.44; 95% CI: 0.1 to 0.99; I2 = 91%; p = 0.11). The analysis showed a significant difference between the subgroups according to regularly administering (4 trials; WMD:-0.11; 95% CI: - 0.32 to 0.09; I2 = 0%; p = 0.28) non-steroidal anti-inflammatory drugs (NSAIDs) or not (3 trials; WMD:1.02; 95% CI: 0.09 to 1.96; I2 = 94%; p = 0.03) for adjuvant analgesics postoperatively. The measured time of the urinary catheter removal in the TAP group was significantly shorter (3 trials, WMD:-18.95, 95% CI:-25.22 to - 12.71; I2 = 0%; p < 0.01), as was time to first ambulation postoperatively (4 trials, WMD:-6.61, 95% CI: - 13.03 to - 0.19; I2 = 67%; p < 0.05). CONCLUSION Continuous TAP block, combined with NSAIDs, can provide non-inferior dynamic analgesia efficacy compared with EA in postoperative pain management after abdominal surgery. In addition, continuous TAP block is associated with fewer postoperative side effects.

中文翻译：

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镇痛效果比较了腹部手术后超声引导的连续横断式腹横肌平面阻滞与硬膜外镇痛的效果：随机对照试验的系统评价和荟萃分析。

背景技术这项综述和荟萃分析旨在评估连续横断腹肌平面（TAP）与硬膜外镇痛（EA）在腹部手术后成人中的镇痛效果。方法从开始到2019年6月，搜索PubMed，Embase和Cochrane中央登记数据库的所有可用随机对照试验（RCT），以评估连续TAP阻滞与EA在腹部手术后的镇痛效果。加权平均差（WMD）是对二元数据具有95％置信区间（CI）和风险比（RR）的连续变量的估计。预先指定的主要结局是术后24小时的动态疼痛评分。结果八项试验包括453例患者（TAP阻滞：224例； EA：229名患者）最终符合纳入标准，荟萃分析包括7项试验。TAP阻滞组和EA组在24小时后的动态疼痛评分相同（WMD：0.44； 95％CI：0.1至0.99； I2 = 91％； p = 0.11）。分析显示，按常规给药方式（4个试验； WMD：-0.11； 95％CI：-0.32至0.09； I2 = 0％； p = 0.28），非类固醇抗炎药（NSAID）在亚组之间存在显着差异。术后是否使用辅助镇痛药（3个试验； WMD：1.02； 95％CI：0.09至1.96； I2 = 94％； p = 0.03）。TAP组测得的导尿管切除时间显着缩短（3次试验，WMD：-18.95，95％CI：-25.22至-12.71； I2 = 0％； p <0.01）术后（4个试验，WMD：-6.61，95％CI：-13.03至-0.19; I2 = 67％; p <0.05）。结论连续TAP阻滞剂与NSAIDs联合使用，与EA相比，在腹部手术后的术后疼痛处理中可提供非劣效的动态镇痛效果。此外，连续的TAP阻滞与较少的术后副作用相关。