TTP4.02 Ultrasound versus laparoscopic guided transversus abdominis plane block for laparoscopic cholecystectomy: a meta-analysis of randomised, controlled trials

Background Adequate post-operative pain management is paramount in patients undergoing laparoscopic cholecystectomy (LC). Various types of plane blocks have been reported in these patients with variable effectiveness. The aim of this meta-analysis is to compare the efficacy of both techniques of transversus abdominis plane (TAP) block. Methods Electronic data was searched to retrieve randomised controlled trials comparing ultrasound guided (U-TAP) versus laparoscopic guided (L-TAP) blocks in patients undergoing LC. Summated data was analysed following the principles of meta-analysis using the statistical software RevMan 5.4. Results Five randomised controlled trials on 348 patients (U-TAP = 172, L-TAP = 176) undergoing LC were found suitable for analysis. In the random effects model analysis, the postoperative pain scores at 1, 2, 6, 12, 24 and 48 hours were statistically similar in both groups. Time to first analgesia and tramadol consumption were also statistically similar in both groups. Postoperative nausea and vomiting, time to first stool and time to first flatus were statistically similar in both groups. Time for L-TAP block was shorter, however this was not statistically significant (standardised mean difference - 8.62, 95% confidence interval (CI): -18.02 to 0.79, z = 1.80, p = 0.07). LC time was significantly shorter in the U-TAP group (standardised mean difference - 0.41, 95% CI: 0.16 to 0.66, z = 3.18, p = 0.001). However, there was significant heterogeneity amongst included studies (Tau² = 45.10; Chi² = 48.67, df = 1 (P < 0.00001); I² = 98%). Conclusions Both U-TAP and L-TAP are equally effective in patients undergoing LC.