Table 1.
Characteristics of the included studies.
| Study | Patients allocation (M/F) and age (years) | Surgery, ASA status, anesthesia technique and postoperative analgesia technique | TAP and epidural block methods | Outcomes |
|---|---|---|---|---|
| Ganapathy2015 | Group T 24 (8/16) Age 58±12.2 yearsGroup E 26 (10/16) Age 61.7±10.8 years | 1. Abdominal laparotomy;2. ASA I–III; 3. General anesthesia; 4. Acetaminophen, naproxen, gabapentin, and either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through the subcostal approach, 0.2% ropivacaine 30 mL followed by 0.35% ropivacaine 4–5 mL/hour for 72 hours.2. Epidural analgesia bupivacaine 0.25% 5 mL followed by 0.1% bupivacaine + hydromorphone 10 µg/mL, 8 mL/hours for 72 hours between T7 and T9. Boluses of hydromorphone were used as rescue analgesia. | 1. Primary outcome was the pain score on coughing 24 hours after surgery.2. Secondary outcomes were pain scores from 24 to 72 hours, intraoperative and postoperative opioid consumption, time to onset of bowel movement, and complications relating to analgesic techniques. |
| Niraj2011 | Group T 27 (18/9) Age 64±12 yearsGroup E 31 (20/11) Age 64±12 years | 1. Abdominal laparotomy; 2. ASA I–III; 3. General anesthesia4. Acetaminophen, tramadol IV and either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through the subcostal approach, 0.375% levobupivacaine 1.25 mg/kg followed by 0.25% levobupivacaine at a rate of 8–10 mL/hour for 72 hours.2. Epidural analgesia bupivacaine 0.25% 20 mL followed by 0.125% bupivacaine +fentanyl 2µg/mL, 8–12 mL/hour for 72 hours with a 2 mL bolus available every 30 minutes between T7 and T9. Boluses of morphine were used as rescue analgesia. | 1. Primary outcome was the pain score on coughing at 8, 24, 48, and 72 hours after surgery.2. Secondary outcomes were VAS score for pain at rest, postoperative nausea, tramadol usage, and patient satisfaction at 72 hours. |
| Niraj2014 | Group T 35 (19/16)Age 66.7±12.6 yearsGroup E 35 (22/13)Age 64.4±16.2 years | 1. Abdominal laparoscopic; 2. ASA I–III; 3. General anesthesia4. Acetaminophen, diclofenac, tramadol IVand either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through intercostoiliac approach, 0.375% ropivacaine 20 mL followed by ropivacaine 0.2% at a rate of 8 mL/hour for 72 hours.2. Epidural analgesia ropivacaine 0.2% 8–15 mL bolus followed by ropivacaine 0.2% , 5–15 mL/hour for 72 hours between T9 and T11.Boluses of morphine were used for rescue analgesia. | 1. The primary outcome was the VAS score for pain on coughing at 24 hours after surgery.2. Secondary outcome measures included visual analog pain scores at rest and on coughing, postoperative nausea scores, tramadol consumption, and patient satisfaction at 48 hours. |
| Kadam2013 | Group T 22 (14/8)Age 63.8±10.1 yearsGroup E 19 (14/5)Age 60.9±13.2 years | 1. Abdominal laparotomy; 2. ASA I–III; 3. General anesthesia; 4. Acetaminophen, IV PCA of fentanyl and either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through intercostoiliac approach, bupivacaine 0.25% 20 mL followed by a 15-mL bolus of bupivacaine 0.25% every 8 hours for 48 hours.2. Epidural analgesia bupivacaine 0.125% 10 mL followed by bupivacaine 0.125%, 6–8 mL/hours for 48 hours between T7 and T9.Boluses of fentanyl were used for rescue analgesia. | 1. Primary outcome was the VAS score for pain on coughing.2. Secondary outcomes were complications relating to analgesic techniques, rescue medication required, and patients’ satisfaction with analgesic techniques. |
| Wahba2014 | Group T 22 (11/11)Age 66.4±4.8 yearsGroup E 22 (10/12)Age 66.3±5.4 years | 1. Abdominal laparotomy; 2. ASA III; 3. General anesthesia4. IV PCA of morphine and either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through intercostoiliac approach, bupivacaine 0.25% 20 mL followed by a 15-mL bolus of bupivacaine 0.25% every 8 hours for 48 hours.2. Epidural analgesia bupivacaine 0.125% 10 mL followed by bupivacaine 0.125%, at a rate of 6 mL/hours for 48 hours between T9 and T11.Boluses of dezocine were used for rescue analgesia. | 1. The primary outcome was morphine consumption at day 1–2 and the time to first request for morphine.2. The secondary outcome was VAS score for pain on coughing and at rest, postoperative sedation, vital signs, and complications relating to analgesic techniques. |
| Zheng2019 | Group T 60 (0/60)Age 33.5±3.5 yearsGroup E 60 (0/60)Age 32.8±3.8 years | 1. Cesarean section delivery; 2. ASA I–II; 3. Combined spinal anesthesia4. Dolantin IV and either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through intercostoiliac approach, ropivacaine 0.375% 3 mL/kg followed by ropivacaine 0.15% at a rate of 2 mL/hour for 48 hours.2. Epidural analgesia ropivacaine 0.75% 1.5 mL followed by ropivacaine 0.15%, at a rate of 4 mL/hour for 48 hours between T9 and T11. | The observational index was the VAS score for pain 2 hours, 6 hours, 12 hours, 24 hours, 36 hours, and 48 hours after surgery, consumption of analgesics within 48 hours and complications relating to analgesic techniques. |
| Qin2017 | Group T 35 (22/13)Age 59.7±8.5 yearsGroup E 36 (21/15)Age 58.0±11.4 years | 1. Abdominal laparoscopic; 2. ASA I–III; 3. General anesthesia4. Either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through intercostoiliac approach, ropivacaine 0.375% 2.5 mg/kg followed by ropivacaine 0.2% at a rate of 6–8 mL/hour for 48 hours.2. Epidural analgesia lidocaine 2% 2 mL followed by a bolus of 1.5–2.5 mL ropivacaine 0.375% every 1–1.5 hours during surgery. Ropivacaine 0.15% at a rate of 4 mL/hour for 48 hours after surgery between T7 and T9. | The observational index was the VAS score for pain 2 hours, 6 hours, 12 hours, and 24 hours, 36 hours, and 48 hours after surgery, patients’ analgesic satisfaction within 48 hours and complications relating to analgesic techniques. |
| Dai2017 | Group T 29 (10/19)Age 52.9±10.8 yearsGroup E 30 (14/16)Age 56.1±12.0 years | 1. Abdominal laparoscopic; 2. ASA I–III 3. General anesthesia4. Either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through the intercostoiliac approach, ropivacaine 0.375% 0.3 mL/kg followed by a bolus of 0.1 mL/kg ropivacaine 0.375% every 2 hours. Ropivacaine 0.2% at a rate of 0.1 mL/kg/hour for 48 hours.2. Epidural analgesia ropivacaine 0.375% 8–10 mL followed by a bolus of 4–5 mL ropivacaine 0.375% every 1–1.5 hours during surgery. Ropivacaine 0.2% at a rate of 3–4 mL/hour for 48 hours after surgery between T9 and T11.Boluses of dezocine were used for rescue analgesia. | The observational index was the VAS score for pain 6 hours, 12 hours, 24 hours, and 48 hours after surgery, patients’ analgesic satisfaction within 48 hours and complications relating to analgesic techniques. |
| Zhang2017 | Group T 25 (0/25)Age 22–40 yearsGroup E 60 (0/60)Age 22–40 yearsGroup E+T 25 (0/25)Age 22–40 years | 1. Cesarean section delivery; 2. ASA I–II; 3. Combined spinal anesthesia; 4. Either TAPB PCA or epidural PCA | 1. Ultrasound-guided bilateral continuous block through the subcostal approach, ropivacaine 0.375% 200 mL followed by a 2-mL bolus of ropivacaine 0.375% every 15 minutes at a rate of 2 mL/hour for 48 hours. 2. Epidural analgesia with 2-mL bolus of ropivacaine 0.375% every 15 minutes at a rate of 2 mL/hour for 48 hours between T7 and T9. | The observational indexes were VAS, BCS, and Ramsay sedation score 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours after surgery; consumption of analgesics within 48 hours; and complications relating to analgesic techniques. |
Group T: Patients underwent continuous transversus abdominis plane block; Group E: Patients underwent continuous epidural analgesic.
Group E+T: Patients underwent a single shot of TAPB and continuous epidural analgesic.
TAPB, transversus plane block; PCA, patient-controlled analgesic; PCIA, patient-controlled intravenous analgesic; IV, intravenous; ASA, American Society of Anesthesiologists; BCS: Bruggrmann Comfort Scale.