Transversus abdominis plane block for postoperative pain management and opioid sparing: a systematic review and meta-analysis of randomised controlled trials.

Summary

Across 123 RCTs, TAP blocks significantly reduced early postoperative pain scores and 24-hour morphine consumption versus placebo and local infiltration. Compared with epidural analgesia, benefits were limited (12-hour pain only), and TAP performed similarly to intrathecal morphine. Findings support TAP block as an effective, opioid-sparing component of multimodal analgesia after abdominal surgery.

Key Findings

• TAP block reduced 6-, 12-, and 24-hour pain scores versus local infiltration (e.g., SMD −0.89 at 6 h; −1.27 at 12 h; −0.66 at 24 h).
• TAP block lowered cumulative 24-hour morphine consumption versus local infiltration (SMD −0.99).
• Benefits versus epidural analgesia were limited to 12-hour pain scores; no significant differences versus intrathecal morphine.

Clinical Implications

Incorporate TAP blocks into standardized multimodal analgesia pathways for abdominal procedures, particularly when epidural is contraindicated or resource-intensive; tailor expectations versus epidural or intrathecal morphine.

Limitations

• Heterogeneity in techniques, local anesthetic dosing, and surgical populations
• Limited data for certain comparators/time points; potential publication bias

Future Directions

Head-to-head trials versus optimized epidurals and intrathecal morphine in defined procedures; dose–response and adjuvant studies; cost-effectiveness and ERAS integration analyses.