Transversus Abdominis Plane Block for Post Hysterectomy Pain: A Systematic Review and Meta-Analysis

The objective of this study was to address the efficacy of transversus abdominis plane (TAP) blocks in pain management among women who undergo elective hysterectomy for benign pathology in both open and minimally invasive surgeries. We performed a systematic review by searching for bibliographic citations from Medline, Embase, and Cochrane Library. MeSH headings for TAP blocks and hysterectomy were combined and restricted to the English language. We included randomized controlled trials comparing TAP blocks with placebo or no block in patients who underwent elective hysterectomy. Pain was measured using a visual analog scale (VAS) on a scale of 0 to 100. We calculated pooled mean differences in VAS and total morphine consumption at 2 and 24 hours by performing a random effects meta-analysis. Fourteen studies met the inclusion criteria, comprising 855 participants. At 2 hours mean VAS scores for patients who underwent TAP blocks were significantly lower after both total abdominal hysterectomy (TAH) (mean difference, -14.97; 95% confidence interval [CI], -20.35 to -9.59) and total laparoscopic hysterectomy (TLH; mean difference, -18.16; 95% CI, -34.78 to -1.53) compared with placebo or no block. Pain scores at 24 hours for patients who underwent TAP blocks were significantly lower after both TAH (-10.09; 95% CI, -17.35 to -2.83) and TLH (-9.12; 95% CI, -18.12 to -.13) compared with placebo or no block. Mean difference in morphine consumption was -9.53 mg (95% CI, -15.43 to -3.63) for TAH and -3.15 mg (95% CI, -8.41 to 2.12) for TLH. In conclusion, TAP blocks provide significant postoperative early and delayed pain control compared with placebo or no block among women who undergo hysterectomy. There was reduced morphine consumption among patients who underwent TAH but not TLH. (C) 2018 AAGL. All rights reserved.