Ultrasound-guided vs. laparoscopic-guided transversus abdominis plane block for postoperative pain following laparoscopic cholecystectomy: a systematic review and meta-analysis

Background: Postoperative pain following laparoscopic cholecystectomy (LC) is a major concern. The transversus abdominis plane block (TAPB) is one of the anesthetic techniques that has been developed to address this issue. The TAPB can be delivered by the guidance of either ultrasound (UTAPB) or laparoscopic (LTAPB). Our aim is to compare the efficacy of these guidance methods in reducing postoperative pain after LC.

Methods: A systematic search was performed in PubMed, Scopus, Cochrane, and Web of Science databases from inception to June 2024 for randomized studies comparing the delivery of TAPB under ultrasound and laparoscopic guidance. Data analysis was conducted using Review Manager V5.4.

Results: Five randomized studies were included in our study. UTAPB was significantly more effective in reducing postoperative pain after 6 h compared to LTAPB (MD = - 0.38, 95% CI, - 0.67 to 0.09, p = 0.01). However, UTAPB was insignificantly more effective than LTAPB in reducing postoperative pain after 12 h (MD = - 0.14, 95% CI, - 0.44 to 0.17, p = 0.39), 24 h (MD = - 0.09, 95% CI, - 0.41 to 0.23, p = 0.60), and 48 h (MD = - 0.12, 95% CI, - 0.44 to 0.19, p = 0.44). UTAPB insignificantly resulted in decreased opioid consumption (SMD: - 0.09; 95% CI: - 0.42, 0.25; p = 0.62) and less postoperative nausea and vomiting (OR = 0.73, 95% CI, 0.21 to 2.51, p = 0.62) in comparison with LTAPB.

Conclusion: Ultrasound guidance of TAPB offers superior pain relief in the setting of LC, especially in the early postoperative period. Further trials are needed to prove and support the results.