Effectiveness of the Transversus Abdominis Plane Block in Post Appendectomy Pain Control: Systematic Review - Abstract
Background: The optimal multimodal strategy for the management of postoperative pain in the pediatric population is still unknown; the use of regional blocks such as transverses abdominis block (TAP) in patients undergoing open appendectomy may reduce morphine requirements and increase the interval between boluses when using PCA.
Objectives: To assess the effectiveness of TAP for the management of postoperative pain in the pediatric population who undergo open or laparoscopic appendectomy by comparing it to the use of placebo, exclusive systemic analgesia or wound infiltration. The secondary outcomes we asses were degree of patient satisfaction, nausea and postoperative and duration of hospitalization
Selection Criteria: Randomized controlled clinical trials in patients younger than 18 years undergoing an open or urgent laparoscopic appendectomy under general anesthesia. The use of transversus abdominis plane block of the abdomen is compared to placebo, exclusive management with systemic analgesia or only wound infiltration.
Data collection and analysis: Three reviewers independently assessed the trials to determine eligibility and risk of bias, then, data extraction was done.
Main Results: Twenty-nine studies conducted until July 2017 was identified. Three of them were included and there were a total of 177 participants. Although not all included studies used the same measure for each outcome, the combination of the results of the three studies suggested that TAP blocks provide effective analgesia after appendectomy in the first two postoperative hours. In addition, when the surgical technique is open, the benefit extends up to 18 hours compared to standard opioid-based postoperative regimens, the consumption of opioids decreases and the time for the first dose increases.