Erector spinae plane block versus transversus abdominis plane block for analgesia after cesarean section: a systematic review and meta-analysis
Bloqueio do plano do músculo eretor da espinha versus bloqueio do plano do músculo transverso do abdome para analgesia após cesariana: uma revisão sistemática e meta-análise
Mariana AbdElSayed Mansour, Saeed Baradwan, Ahmed Abdelaziz Shama, Mohamed Ali Mahmoud, Ayman Salah Abouelnour, Ayman Mohamed AbdelWahed Mohamed, Ahmed Fathi Hassan Elkhouly, Abdelkarem Hussiny Ismail Elsayed, Zaky Ftouh Rashed, Ahmed Mohamed Abdelhakim, Mrooj Mabruk Almutairi, Mohamed A. Lotfy, Ahmed Goda Ahmed
Abstract
Introduction
Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.
Methods
A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).
Resultados
Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p < 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p < 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I2 = 83%), requiring cautious interpretation.
Conclusão
The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.
Keywords
Resumo
Introdução
Bloqueios nervosos periféricos abdominais são componentes-chave da analgesia multimodal, favorecendo a recuperação após cesarianas. Esta revisão sistemática e meta-análise teve como objetivo avaliar a eficácia analgésica do Bloqueio do Plano do Músculo Eretor da Espinha (ESPB) em comparação ao Bloqueio do Plano do Músculo Transverso do Abdome (TAPB) guiados por ultrassonografia após cesariana sob anestesia raquidiana.
Métodos
Foi realizada busca abrangente nas bases PubMed, Scopus, Cochrane Library e ISI Web of Science para identificar ensaios relevantes. Os critérios de inclusão seguiram o modelo PICOS: População (mulheres submetidas a cesariana eletiva), Intervenção (ESPB), Comparador (TAPB), Desfechos (dor pós-operatória, consumo de opioides, duração da analgesia e satisfação), e Desenho do Estudo (ensaios clínicos randomizados).
Resultados
Sete ECRs (380 pacientes) atenderam aos critérios. O grupo ESPB apresentou escores de dor pós-operatória significativamente menores em repouso e movimento, redução do consumo de opioides em 24 horas (MD = -2,62 MME; IC 95% -4,11 a -1,13; p = 0,006) e maior duração da analgesia (SMD = 1,77; IC 95% 1,11 a 2,44; p < 0,001) em comparação ao grupo TAPB. A satisfação dos pacientes também foi significativamente maior no grupo ESPB (OR = 4,75; IC 95% 2,26 a 9,99; p < 0,001). A maioria dos desfechos mostrou baixa heterogeneidade, exceto a duração da analgesia (I² = 83%), o que requer interpretação cautelosa.
Conclusão
O bloqueio ESP oferece alívio da dor superior, reduz o uso de opioides e aumenta a satisfação em comparação ao bloqueio TAP em cesarianas. Esses achados sugerem que a implementação do bloqueio ESP em protocolos de analgesia pós-operatória pode melhorar significativamente os resultados para as pacientes, promovendo recuperação otimizada e menor dependência de opioides.
Palavras-chave
References
1. Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6:e005671.
2. Borges NC, Pereira LV, Moura LA, Silva TC, Pedroso CF. Predictors for Moderate to Severe Acute Postoperative Pain after Cesarean Section. Pain Res Manag. 2016;2016:5783817.
3. Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth. 2019;40:78−90.
4. Zandomenico JG, Perito GZ, Machado JA, Silva HCG. Postoperative pain management after cesarean delivery: cross-sectional study. Braz J Anesthesiol. 2022;72:533−5.
5. Komatsu R, Ando K, Flood PD. Factors associated with persistent pain after childbirth: a narrative review. Br J Anaesth. 2020;124:e117−30.
6. Shen D, Hasegawa-Moriyama M, Ishida K, Fuseya S, Tanaka S, Kawamata M. Acute postoperative pain is correlated with the early onset of postpartum depression after cesarean section: a retrospective cohort study. J Anesth. 2020;34:607−12.
7. Chang C-Y, Tu Y-K, Kao M-C, et al. Effects of opioids administered via intravenous or epidural patient-controlled analgesia after caesarean section: a network meta-analysis of randomised controlled trials. eClinicalMedicine. 2023;56:101787.
8. Holland E, Sudhof LS, Zera C. Optimal pain management for cesarean delivery. Int Anesthesiol Clin. 2020;58:42.
9. Aly M, Ibrahim A, Farrag W, Abdelsalam K, Mohamed H, Tawfik A. Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. 2018;35:52−6.
10. Zanolli NC, Fuller ME, Krishnamoorthy V, Ohnuma T, Raghunathan K, Habib AS. Opioid-Sparing Multimodal Analgesia Use After Cesarean Delivery Under General Anesthesia: A Retrospective Cohort Study in 729 US Hospitals. Anesth Analg. 2023;137:256−66.
11. Ryu C, Choi GJ, Jung YH, Baek CW, Cho CK, Kang H. Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis. J Pers Med. 2022;12:634.
12. Mallan D, Sharan S, Saxena S, Singh TK. Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks. Local Reg Anesth. 2019;12:81−8.
13. Zhao X, Tong Y, Ren H, et al. Transversus abdominis plane block for postoperative analgesia after laparoscopic surgery: a systematic review and meta-analysis. Int J Clin Exp Med. 2014;7:2966−75.
14. Habib AS, Nedeljkovic SS, Horn J-L, et al. Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. J Clin Anesth. 2021;75:110527.
15. Kintu A, Abdulla S, Lubikire A, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res. 2019;19:68.
16. Alt{parmak B, Korkmaz Toker M, Uysal AI, Kus¸cu Y, G ¸ um€ u€s Demi- ¸ rbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. J Clin Anesth. 2019;57:31−6.
17. Jain K, Jaiswal V, Puri A. Erector spinae plane block: Relatively new block on horizon with a wide spectrum of application − A case series. Indian J Anaesth. 2018;62:809−13.
18. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41:621−7.
19. Qi-Hong S, Xu-Yan Z, Xu S, Yan-Jun C, Ke L, Rong W. Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study. Pain Ther. 2021;10:1709−18.
20. Silverman M, Zwolinski N, Wang E, et al. Regional Analgesia for Cesarean Delivery: A Narrative Review Toward Enhancing Outcomes in Parturients. J Pain Res. 2023;16:3807−35.
21. Aygun H, Ozturk NK, Ugur M, et al. Evaluation of ultrasoundguided bilateral low thoracic erector spinae plane block for postoperative analgesia in cesarean delivery patients: a prospective, randomized, controlled clinical trial. Braz J Anesthesiol Engl Ed. 2022;72:444−9.
22. Malawat A, Verma K, Jethava D, Jethava DD. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol. 2020;36:201−6.
23. Boules ML, Goda AS, Abdelhady MA, Abu El-Nour Abd ElAzeem SA, Hamed MA. Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study. J Pain Res. 2020;13:1073−80.
24. Eksteen A, Wagner J, Kleyenstuber T, Kamerman P. Comparison of erector spinae plane and transversus abdominis plane blocks for postoperative analgesia after caesarean delivery under spinal anaesthesia: a randomised controlled trial. Int J Obstet Anesth. 2024;60:104259.
25. Reddy NVK, Prabhu M, Kanakalakshmi ST, Muhamed S. Randomized comparison between transversus abdominis and erector spinae blocks in cesarean section. Colomb J Anesthesiol. 2023;51:1−8.
26. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
27. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
28. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
29. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38.
30. Wasserstein RL, Lazar NA. The ASA Statement on p-Values: Context, Process, and Purpose. Am Stat. 2016;70:129−33.
31. Julian T Higgins AP, Thompson SG, Deeks JJ. Measuring inconsistency in meta-analyses Rapid responses Topic collections. 2003;327:557-60.
32. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 2015;14:1−16.
33. Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Stat Med Stat Med. 2003;22:2113−26.
34. Balata AAA, El-Dorgham LT, Ismai HAM, El-Dorgham LT. Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Postcesarean Delivery Pain under Spinal Anesthesia. Egypt J Hosp Med. 2023;91:4265−71.
35. Elshafay A, Hegazy EM, Ashour FH. Abd-Almoniem MF. Analgesic Effect of Erector Spinae Plane Block versus Transversus Abdominis Plane Block After Elective Cesarean Section. Al-Azhar Univ J Med Virus Res Stud. 2022;4:1−11.
36. Yilmaz MA, Erol MK. Comparison of The Effects of Erector Spina Plane Block and Transversus Abdominis Plane Block Methods on Postoperative Analgesia in Elective Caesarian Section with Ultrasonography Account. Int J Curr Med Biol Sci. 2023;3:120−9.
37. VR Junior I do, Carvalho VH, Brito LGO. Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis. Braz J Anesthesiol. 2022;72:506−15.
38. Hamed MA, Yassin HM, Botros JM, Abdelhady MA. Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study. J Pain Res. 2020;13:597−604.
39. Zanfini BA, Di Muro M, Biancone M, et al. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med. 2023;12:7720.
40. Bakshi A, Srivastawa S, Jadon A, Mohsin K, Sinha N, Chakraborty S. Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia ‒ A randomised study. Indian J Anaesth. 2022;66(Suppl 4):S213−9.
41. Joshi R, Jeevan R, Amutha SV, Ramakrishnan L, Natarajan NR. Comparison of ultrasound-guided erector spinae plane block versus transmuscular quadratus lumborum block for postoperative analgesia after caesarean delivery: A prospective randomized non-inferiority clinical trial. J Anaesthesiol Clin Pharmacol. 2024;40:478.
42. Saadawi M, Layera S, Aliste J, Bravo D, Leurcharusmee P, Tran DQ. Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. J Clin Anesth. 2021;68:110063.
43. Ueshima H, Otake H. Similarities Between the Retrolaminar and Erector Spinae Plane Blocks. Reg Anesth Pain Med. 2017;42:123−4.
44. Tsai H-C, Yoshida T, Chuang T-Y, et al. Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BioMed Res Int. 2017;2017:8284363.
45. Kot P, Rodriguez P, Granell M, et al. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72:209−20.
Submitted date:
10/22/2024
Accepted date:
02/26/2025
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