title: Ultrasound-Guided Transversus Abdominis Plane Block for Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To evaluate the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing laparoscopic cholecystectomy (LC).
  
  
  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, 95% confidence interval, CI: -3.46 to -0.91, p = 0.0008; on movement: MD(0 h) = -2.67, 95% CI: -3.86 to -1.48, p < 0.0001); (2) intraoperative fentanyl consumption (MD = -27.85 µg, 95% CI: -44.91 to -10.79, p = 0.001), and (3) morphine consumption in the recovery room (MD = -1.57 mg, 95% 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, 95% CI: 0.20 to 0.62, p = 0.0003). TAP blocks also reduced postoperative nausea and vomiting (RR = 0.48, 95% 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.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Peng
authors.forename: Fu-hai
authors.initials: FH
authors.lastname: Ji
authors.forename: Hua-yue
authors.initials: HY
authors.lastname: Liu
authors.forename: Shao-ru
authors.initials: SR
authors.lastname: Wu
mesh_terms: D000009:Abdominal Muscles; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D006801:Humans; D019148:Neuromuscular Blockade / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid