A Systematic Review and Meta-Analysis Comparing the Effectiveness of Transversus Abdominis Plane Block and Caudal Block for Relief of Postoperative Pain in Children Who Underwent Lower Abdominal Surgeries

作者全名："Xiao, Dan; Sun, Yiyuan; Gong, Fang; Yin, Yu; Wang, Yue"

作者地址："[Xiao, Dan; Gong, Fang; Wang, Yue] Chongqing Med Univ, Yongchuan Hosp, Dept Pediat, Chongqing 402160, Peoples R China; [Sun, Yiyuan; Yin, Yu] Sichuan Univ, West China Hosp, Day Surg Ctr, Gen Practice Med Ctr, Chengdu 610017, Peoples R China"

通信作者："Gong, F (通讯作者)，Chongqing Med Univ, Yongchuan Hosp, Dept Pediat, Chongqing 402160, Peoples R China."

来源：MEDICINA-LITHUANIA

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001073605300001

JCR分区：Q1

影响因子：2.4

年份：2023

卷号：59

期号：9

开始页：　

结束页：　

文献类型：Review

关键词：pain scores; abdominal surgery; caudal block (CB); transversus abdominis plane block (TAPB); meta-analysis

摘要："Background and Objectives: Postoperative pain after lower abdominal surgery is typically severe. Traditionally, in pediatric anesthesia, a caudal block (CB) has been used for pain management in these cases. Nowadays, a transversus abdominis plane block (TAPB) seems to be an effective alternative. However, which technique for perioperative analgesia is better and more effective remains unclear in children who undergo abdominal surgeries. The aim of this study was to compare the efficacy and safety of a TAPB and CB for pain management in children after abdominal surgery by conducting a meta-analysis of published papers in this area. Methods: We conducted a thorough search of PubMed, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trials (RCTs) that compared a TAPB and CB for pain management in children who had abdominal surgery. Two researchers screened and assessed all the information with RevMan5.3 used for this meta-analysis. Pain scores, the total dose of rescue analgesic given, the mean duration of analgesia, the intraoperative and postoperative hemodynamic conditions 24 h after surgery, and adverse events were compared. Results: 15 RCTs that involved a total of 970 pediatric patients were included in this study. The results of this meta-analysis showed that there were no significant differences between the 2 groups in terms of postoperative pain scores at 1 h (SMD = 0.35; 95% CI = -0.54 to 1.24; p = 0.44, I2 = 94%), 6 h (SMD = -0.10; 95% CI = -0.44 to -0.23; p = 0.55, I2 = 69%), 12 h (SMD = -0.02; 95% CI = -0.45 to -0.40; p = 0.93, I2 = 80%), and 24 h (SMD = -0.66; 95% CI = -1.57 to -0.25; p = 0.15, I2 = 94%); additional analgesic requirement (OR 0.25; 95% CI 0.09 to 0.63; p = 0.004, I2 = 72%); total dose of rescue analgesic given in 24 h (SMD = -0.37; 95% CI = -1.33 to -0.58; p = 0.44; I2 = 97%); mean duration of analgesia (SMD = 1.29; 95% CI = 0.01 to 2.57; p = 0.05, I2 = 98%); parents' satisfaction (SMD = 0.44; 95% CI = -0.12 to 1.0; p = 0.12; I2 = 80%); and intraoperative and postoperative hemodynamic conditions 24 h after the surgery and adverse events (SMD = 0.78; 95% CI = 0.22 to 2.82; p = 0.70; I2 = 62%). Compared to a CB, a TAPB resulted in a small but significant reduction in additional analgesic requirement after surgery (OR 0.25; 95% CI 0.09 to 0.63; p = 0.004). Conclusions: TAPBs and CBs result in similar efficient early analgesia and safety profiles in children undergoing abdominal surgeries. Moreover, no disparities were observed for adverse effects between TAPBs and CBs."

基金机构：Postgraduate Innovation Foundation of Yongchuan Hospital affiliated with Chongqing Medical University [YJSCX202203]

基金资助正文：This study was funded by the Postgraduate Innovation Foundation of Yongchuan Hospital affiliated with Chongqing Medical University (YJSCX202203).