Laparoscopic-assisted versus ultrasound-guided transversus abdominis plane block for laparoscopic abdominal surgeries: a systematic review and meta-analysis.

BACKGROUND

The Transversus Abdominis Plane block, performed using either laparoscopy-assisted or ultrasound-guided techniques, has emerged as a valuable option for managing postoperative pain in laparoscopic abdominal surgeries. Ultrasound guidance improves the accuracy and safety of anaesthetic administration, whereas the laparoscopy-assisted technique enables direct visualization of the injection site and anaesthetic dispersion, potentially increasing precision and reducing performance time. Previous meta-analyses have yielded limited results, largely due to their narrow focus on specific surgeries or heterogeneous study designs.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effectiveness of LTAP and UTAP in adult patients undergoing laparoscopic abdominal surgery. Databases searched included MEDLINE, Cochrane Library, Embase, and Web of Science, following PRISMA and Cochrane Handbook guidelines. Eligible studies enrolled adult patients (P) undergoing laparoscopic abdominal surgery who received LTAP (I) or UTAP (C), with outcomes including postoperative pain and analgesic requirements (O).

RESULTS

Thirteen RCTs comprising 1254 patients undergoing cholecystectomy, bariatric surgery, or colorectal surgery were analysed. Laparoscopy-assisted Transversus Abdominis Plane block trended to marginally lower pain scores at 24 h (mean difference - 0.25, 95% confidence interval - 0.51 to 0.02, P = 0.066) and required significantly less time for performance (mean difference - 6.78 min, 95% confidence interval - 8.69 to - 4.87, P < 0.000001). No significant differences were observed in cumulative morphine consumption, time to the first analgesic request, or total surgical duration.

CONCLUSIONS

Both techniques provide effective postoperative analgesia. The laparoscopy-assisted approach may provide a procedural efficiency advantage due to shorter performance time. These findings support its application across a range of laparoscopic abdominal surgeries and underscore the need for further research to consolidate these advantages.