Ultrasound-Guided Transversus Abdominis Plane Block for Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

OBJECTIVES: To evaluate the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing laparoscopic cholecystectomy (LC). MATERIALS AND METHODS: A systematic literature search was conducted to identify randomized controlled trials that compared ultrasound-guided TAP block with control for analgesia in adult patients undergoing LC. The original data were pooled for the meta-analysis using Review Manager 5. The main outcomes included postoperative pain intensity, opioid consumption, and adverse events. Out of a total of 77 trials, 7 were included. RESULTS: Compared with control, ultrasound-guided TAP block reduced the following: (1) postoperative pain intensity (visual analog scale: 0–10) both at rest and on movement at 0, 2, 4, 8, and 24 h (at rest: mean difference, MD(0 h) = −2.19, 95s% confidence interval, CI: −3.46 to −0.91, p = 0.0008; on movement: MD(0 h) = −2.67, 95s% CI: −3.86 to −1.48, p < 0.0001); (2) intraoperative fentanyl consumption (MD = −27.85 µg, 95s% CI: −44.91 to −10.79, p = 0.001), and (3) morphine consumption in the recovery room (MD = −1.57 mg, 95s% CI: −3.0 to −0.14, p = 0.03) and 0–24 h postoperatively. Fewer patients required analgesics in the recovery room when receiving TAP blocks (risk ratio, RR = 0.35, 95s% CI: 0.20 to 0.62, p = 0.0003). TAP blocks also reduced postoperative nausea and vomiting (RR = 0.48, 95s% CI: 0.28 to 0.81, p = 0.006). None of the studies reported symptoms of local anesthetic toxicity. CONCLUSIONS: In this study, the ultrasound-guided TAP block was an effective strategy for analgesia in patients undergoing LC.