The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs: A systematic review and meta-analysis with trial sequential analysis.

Abstract

BACKGROUND:

Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair.

OBJECTIVES:

To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair.

DESIGN:

Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES:

MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020.

ELIGIBILITY CRITERIA:

We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic.

RESULTS:

Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of -0.8 (-1.3 to -0.2); I2  = 85%; P   =  0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate.

CONCLUSION:

There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair.

TRIAL REGISTRY NUMBER:

PROSPERO CRD42020208053.

• Authors: Sina Grape, Kyle R Kirkham, Eric Albrecht
• Journal: European journal of anaesthesiology (Eur J Anaesthesiol) Vol. 39 Issue 7 Pg. 611-618 (07 01 2022) ISSN: 1365-2346 [Electronic] England
• PMID: 35131973 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

Chemical References

• Analgesics
• Analgesics, Opioid
• Anesthetics, Local

Topics

• Abdominal Muscles
• Analgesics (therapeutic use)
• Analgesics, Opioid (therapeutic use)
• Anesthetics, Local (therapeutic use)
• Hernia, Inguinal (surgery)
• Hernia, Umbilical (drug therapy, surgery)
• Humans
• Pain, Postoperative (diagnosis, etiology, prevention & control)