Article type
Abstract
Background: Laparoscopic nephrectomy is commonly performed surgery for renal tumor or live donor. Recently, several abdominal wall blocks using ultrasound have been used for laparoscopic nephrectomy. Among these, both transversus abdominis plane (TAP) and quadratus lumborum (QL) block are known for being relatively easy to perform while still being effective.
Objectives : This study aimed to assess the comparative efficacy of regional analgesic interventions, such as the mentioned blocks, in laparoscopic nephrectomy.
Methods: It conducted a network meta-analysis using indirect comparisons with systemic analgesia. We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery, while the pain score, estimated postoperatively at three different time periods, was the secondary objective. We considered reductions 10 mg intravenous morphine equivalent in the first 24 hours postoperatively and 1 of pain score in each time periods to be clinically important. Results were pooled using random effects modeling.
Results: A total of 12 studies were included. Both abdominal wall block techniques were superior to systemic analgesia at reducing opioid consumption. However, the 95% confidence interval of the mean difference did not exceed the predetermined minimal clinically important difference (MCID). Pain scores at each time period also showed significant differences compared to systemic analgesia but were not clinically meaningful. The analgesic effect of both block techniques was comparable, making it difficult to determine superiority.
Conslusions: Abdominal wall blocks including TAP and QL block demonstrated a significant analgesic effect compared to the control group, although it was not clinically meaningful. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following laparoscopic nephrectomy.
Key words: Pain, Postoperative, Systematic review, Meta-analysis
Objectives : This study aimed to assess the comparative efficacy of regional analgesic interventions, such as the mentioned blocks, in laparoscopic nephrectomy.
Methods: It conducted a network meta-analysis using indirect comparisons with systemic analgesia. We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery, while the pain score, estimated postoperatively at three different time periods, was the secondary objective. We considered reductions 10 mg intravenous morphine equivalent in the first 24 hours postoperatively and 1 of pain score in each time periods to be clinically important. Results were pooled using random effects modeling.
Results: A total of 12 studies were included. Both abdominal wall block techniques were superior to systemic analgesia at reducing opioid consumption. However, the 95% confidence interval of the mean difference did not exceed the predetermined minimal clinically important difference (MCID). Pain scores at each time period also showed significant differences compared to systemic analgesia but were not clinically meaningful. The analgesic effect of both block techniques was comparable, making it difficult to determine superiority.
Conslusions: Abdominal wall blocks including TAP and QL block demonstrated a significant analgesic effect compared to the control group, although it was not clinically meaningful. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following laparoscopic nephrectomy.
Key words: Pain, Postoperative, Systematic review, Meta-analysis