Transversus Abdominal Plane Block Versus Thoracic Epidural Block For Postoperative Analgesia In Adults:a Meta-analysis

Objective:The comparison of the efficacy of transabdominal plane block(TAPB)and thoracic epidural analgesia(TEA)in abdominal surgery has always been controversial.The existing clinical randomized controlled trials were reviewed and meta-analyzed to evaluate the specific effects of TAP block and TEA in abdominal surgery.Methods:We totally conducted a systematic literature search on the databases of Pub Med,Embase,Cochrane Library,Scopus,CNKI,Wanfang and VIP until January 1,2021 to determine the randomized controlled trial(RCT)comparing TAP block and TEA in colorectal surgery.After two evaluators independently screened the literature,extracted the data and evaluated the quality of the methodology included in the study,the Rev Man5.3software was used for Meta analysis.Results:A total of 1123 patients were enrolled in 13 randomized controlled trials(TAPB group = 568,TEA group = 555).The methodological quality of these randomized controlled trials was highly different.The results of Meta analysis are as follows:1.VAS scores between the two groups showed no significant difference at rest or activity at 12 h after surgery(p>0.05);at rest 24 h after surgery,differences in VAS scores between the two groups were statistically significant(p<0.05).The VAS score of the TAPB group was significantly better than that of the TEA group;VAS scores between the two groups showed no significant difference when exercising at 24 hours postoperatively(p>0.05).2.There was no statistically significant difference in the amount of opioid drugs used 48 hours after operation between the two groups(p>0.05).3.Compared with the TEA group,the TAPB group had a lower incidence of postoperative nausea and vomiting,and there was significant difference between the two groups(p<0.05).4.Postoperative urinary retention(the time of catheter removal in),TAPB group was significantly shorter than that in TEA group(p <0.05).5.The total postoperative hospital stay in the TAPB group was significantly shorter than that in the TEA group,and the difference was statistically significant(p<0.05).6.In the satisfaction score of postoperative analgesia,the score of patients in TAPB group was higher than that in TEA group,and the difference was statistically significant(p<0.05),indicating that patients were more satisfied with TAPB block.Conclusion:TAP block is similar to TEA in postoperative pain control,and a larger sample size may be needed for clinical study.However,TAPB was superior to TEA in postoperative nausea and vomiting,urinary retention time,total hospital stay and patient satisfaction.