Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review

Ripollés, Javier; Mezquita, Sandra Marmaña; Abad, Alfredo; Calvo, José

doi:10.1016/j.bjane.2013.10.016

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Review Articles • Rev. Bras. Anestesiol. 65 (4) • Aug 2015 • https://doi.org/10.1016/j.bjane.2013.10.016 linkcopy

Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

BACKGROUND: The transverse abdominal plan blockade is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that were carried out according to the descriptions, and the prospective studies would make it possible to utilize the transverse abdominal plan blockade in different surgical interventions; however, the results obtained in randomized clinical trials are inconsistent.

OBJECTIVES: To prepare a systematic review aiming to determine the efficacy of the ultrasound-guided transverse abdominal plan blockade for different surgical interventions, as well as the indications according to the approaches and their influences.

METHODS: Two research approaches, one manual, and the other in Pubmed returned 28 randomized clinical trials where intervention with ultrasound-guided transverse abdominal plan blockades was performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score > 1, according to the inclusion criteria for this review. The authors analyzed independently all the randomized clinical trials.

CONCLUSIONS: The transverse abdominal plan blockades have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in randomized clinical trial are not conclusive, and as a result, it is necessary to develop new and well designed randomized clinical trial, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

TAP block; Transversus abdominis plane; Ultrasound guided; Sistematic review

Surgery Author, year	N	Intervention	Comparison	Outcome	Design	Jadad Score
C. colorectal
Niraj et al., 2011¹⁷	62	Bilateral TAP with catheter in high abdominal surgery	TAP vs. epidural	VAS pain score at rest and in movement in the first 72 h	Randomized double-blind trial	5
Walter et al., 2013¹⁸	68	Bilateral TAP in c. colorectal	TAP vs. no TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5

Cesarean
Belavy et al., 2009¹⁹	57	Bilateral TAP in cesarean with spinal anesthesia	TAP vs. placebo TAP	Consumption of opioids in the first 24 h	Randomized blind trial	5
Costello et al., 2009²⁰	96	Bilateral TAP in cesarean with spinal anesthesia with ITM	TAP vs. placebo TAP	VAS pain score at rest and in movement in the first 24 h	Randomized double-blind trial	5
Baaj et al., 2010²¹	40	Bilateral TAP in cesarean with spinal anesthesia	TAP vs. placebo TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	3
Kanazi et al., 2010²²	57	ITM in cesarean	TAP vs. ITM + placebo TAP	Time until the opioid rescue	Randomized double-blind trial	4
Loane et al., 2012²³	66	Bilateral TAP in cesarean under spinal anesthesia	TAP vs. ITM + placebo TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5
Tan et al., 2012²⁴	40	Bilateral TAP in cesarean with general anesthesia	TAP vs. placebo TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5
Bollag et al., 2012²⁵	90	Bilateral TAP with clonidine in cesarean with spinal anesthesia	clonidine TAP vs. TAP vs. placebo TAP	Hyperalgesia index of the wound following TAP	Randomized double-blind trial	5
Eslamian et al., 2012²⁶	50	Bilateral TAP in cesarean with general anesthesia	TAP vs. no TAP	VAS pain score at rest and in movement in the first 24 h	Randomized double-blind trial	5
Cánovas et al., 2013²⁷	90	Bilateral TAP in cesarean with spinal anesthesia	TAP vs. placebo TAP vs. ITM + placebo TAP	VAS pain score at rest and in movement in the first 24 h	Randomized double-blind trial	5
Lee et al., 2013²⁸	51	Bilateral TAP in cesarean with spinal anesthesia with ITM	TAP vs. placebo TAP	VAS pain score in movement in the first 48 h	Randomized double-blind trial	5

Cholecystectomy
El-Dawlatly et al., 2009²⁹	42	Bilateral TAP in laparoscopic cholecystectomy	TAP vs. no TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	3
Ra et al., 2010³⁰	54	Bilateral TAP in laparoscopic cholecystectomy	TAP vs. placebo TAP	Numerical and verbal pain score in the first 24 h	Randomized blind trial	3
Petersen et al., 2012³¹	80	Bilateral TAP in laparoscopic cholecystectomy	TAP vs. placebo TAP	VAS pain score in movement in the first 24 h	Randomized double-blind trial	5
Ortiz et al., 2012³²	80	Bilateral TAP in laparoscopic cholecystectomy	TAP vs. infiltration	VAS pain score in the first 24 h	Randomized blind trial	3
Tolchard et al., 2012³³	43	Bilateral TAP in laparoscopic cholecystectomy	TAP vs. infiltration	Consumption of opioids in the first 24 h Reduction of VAS	Randomized double-blind trial	5

Gynecological
Griffiths et al., 2010³⁴	65	Bilateral TAP in oncologic gynecological surgery	TAP vs. placebo	Consumption of opioids in the first 24 h Reduction of VAS	Randomized double-blind trial	5
Atim et al., 2011³⁵	55	Bilateral TAP in hysterectomy	TAP vs. TAP placebo vs. local infiltration	VAS pain score at rest and in movement in the first 24 h	Randomized double-blind trial	2
De Oliveira et al., 2011³⁶	75	Bilateral TAP in gynecological c. laparoscopic	TAP vs. placebo TAP	QoR-40 satisfaction score	Randomized double-blind trial	5
Kane et al., 2012³⁷	56	Bilateral TAP in laparoscopic hysterectomy	TAP vs. no TAP	Satisfaction score QoR-40	Randomized blind trial	3

H. inguinal
Aveline et al., 2011³⁸	275	Unilateral TAP in inguinal herniorrhaphy	TAP vs. b. ileoinguinal-ileohipogastric	VAS pain score at rest and in movement in the first 24 h	Randomized blind trial	3
López González et al., 2013³⁹	41	Unilateral TAP in inguinal herniorrhaphy	TAP vs. infiltration	VAS pain score at rest and im movement in the first 24 h	Randomized blind trial	2
Petersen et al., 2013⁴⁰	90	Unilateral TAP in inguinal herniorrhaphy	TAP vs. Placebo TAP vs. IIB + infiltration LA	VAS pain score at rest and in movement in the first 24 h	Randomized double-blind trial	5

Appendectomy
Niraj et al., 2009⁴¹	52	Unilateral TAP in open appendectomy	TAP vs. no TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5

Nephrectomy
Hosgood et al., 2012⁴²	46	TAP in donor nephrectomy	TAP vs. placebo TAP	Consumption of opioids in the first 48 h and VAS pain score	Randomized double-blind trial	5
Parikh et al., 2013⁴³	60	TAP in donor nephrectomy	TAP vs. placebo TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5

Bariatric
Sinha et al., 2013⁴⁴	100	TAP in bariatric surgery (laparoscopic Y-Roux anastomosis)	TAP vs. placebo TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5
Albrecht et al., 2013⁴⁵	70	TAP in bariatric surgery with local infiltration LA	TAP vs. no TAP	Consumption of opioids in the first 24 h	Randomized double-blind trial	5

Gastrectomy
Wu et al., 2013⁴⁶	90	TAP in radical gastrectomy	TAP vs. epidural vs. no intervention	Consumption of opioids in the first 24 h and VAS pain score	Randomized double-blind trial	5
Elkassabany et al., 2013⁴⁷	52	Bilateral TAP in retropubic radical prostatectomy	TAP vs. placebo TAP	VAS pain score and consumption of opioids in the first 24 h	Randomized double-blind trial	5

Author, year	N	Groups (n)	Pain score – at rest		Pain score – in movement		Consumption of analgesics		Opioid rescue time	Adverse effects related to opioids			Conclusions
			Early	Late	Early	Late	Early	Late		NVPO	Itching	Sedation
Niraj et al., 2011¹⁷	62	1 – TAP n 27 2 – TAP n 31					NA		-	NA		NA	There is no difference between VAS score in rest and during movements in the first 72 h with TAP or epidural
Walter et al., 2013¹⁸	68	1 – TAP n 33 2 – No TAP n 35					NA		NA				TAP reduces around 33% the mean consumption of opioids in the first 24 h (20 mg); p < 0.05
Belavy et al., 2009¹⁹	57	1 – TAP n 23 2 – placebo TAP n 24					NA		+	-			TAP reduces the mean consumption of opioids in the first 24 h (13.5 mg); p < 0.05
Costello et al., 2009²⁰	96	1 – TAP n 47 2 – placebo TAP n 49					ND		No	NA	NA	NA	TAP does not reduce the VAS score in the first 24 h
Baaj et al., 2010²¹	40	1 – TAP n 20 2 – placebo TAP n 20	+	+	+	+	NA		NA	+	NA	NA	TAP reduces the mean consumption of opioids in the first 24 h (25.89 mg vs. 62 mg; p < 0.05)
Kanazi et al., 2010²²	57	1 – ITM n 28 2 – TAP n 29	-		-		NA		-	+	+		TAP extends around 50% (TAP 8 h, MIT 4 h) the time since the first opioid rescue (p < 0.05)
Loane et al., 2012²³	66	1 – TAP n 33 2 – ITM + placebo TAP n 33	-	-	-	-	NA			+	+		TAP increases the mean consumption of opioids in the first 24 h (7.5 mg vs. 2.7 mg; p = 0.03)
Tan et al., 2012²⁴	40	1 – TAP n 20 2 – placebo TAP n 20					NA		NA				TAP reduces the mean consumption of opioids in the first 24 h (12.3 mg vs. 31.4 mg; p < 0.01)
Bollag et al., 2012²⁵	90	1 – TAP placebo n 30 2 – TAP n 25 3 – TAP clonidine n 26	-		-		+	+	NA	NA	NA	NA	To add clonidine to TAP with bupivacaine does not improve the injuries hyperalgesia rate, and it does not improve the VAS score at rest and in movement
Eslamian et al., 2012²⁶	50	1 – TAP n 23 2 – No TAP n 25	+		+	+	+	+	+	NA	NA	NA	TAP reduces the VAS score at rest and in movement, as well as the consumption of opioids in the first 24 h (50 mg tramadol vs. 150 mg tramadol; p= 0.0001)
Cánovas et al., 2013²⁷	90	1 – ITM + placebo TAP n 30 2 – placebo TAP 3 – TAP	+	+	+	+	+	+	+	+	+		TAP reduces the VAS score at rest, 12/24 h (p < 0.05), and in movement (p ≤ 0.02)
Lee et al., 2013²⁸	51	1 – TAP n 26 2 – placebo TAP n 25	+		+		+	+					TAP reduces the pain score at rest and in movement in the first 2 postoperative hours (0.5 and 1.9 vs. 2.8 and 4.9; p < 0.001)
El-Dawlatly et al., 2009²⁹	42	1 – TAP n 21 2 – No TAP n 21	NA	NA	NA	NA	+	+	NA	NA	NA	NA	TAP reduces the intraoperative consumption of sufentanyl (p< 0.01), and also reduces the consumption of morphine in the first 24 h (12.3 mg; p < 0.05)
Ra et al., 2010³⁰	54	1 – TAP 0.5% n 18 2 – TAP 0.25% n 18 3 – No TAP	+	+	+	+	+	+	NA	NA	NA	+	TAP 0.25% and TAP 0.5% reduce verbal-numerical pain score in the first 24 h (p < 0.001). There are no differences between TAP 0.25% and TAP 0.5%. TAP reduces the consumption of intraoperative remifentanyl and also reduces the consumption of analgesics in postoperative (p < 0.001). There are no differences between TAP 0.25% and TAP 0.5%
Petersen et al., 2012³¹	80	1 – TAP n 37 2 – placebo TAP n 37		+		+	+		NA		NA		TAP reduces the VAS pain score in movement, calculated as the area under the curve in the first 24 h (26 mm vs. 34 mm; p = 0.04)
Ortiz et al., 2012³²	80	1 – TAP n 39 2 – local infiltration n 35					NA		NA	NA	NA	NA	TAP does not reduce the VAS score in the first 24 h
Tolchard et al., 2012³³	43	1 – TAP n 21 2 – local infiltration n 22	+	NA	+	NA	-		NA	NA	NA	NA	TAP reduces VAS in the first 8 h (p < 0.01) TAP reduces the consumption of opioids in the first 8 h (9.2 mg vs. 16.8 mg; p < 0.01)
Griffiths et al., 2010³⁴	65	1 – TAP n 32 2 – placebo TAP n 33							NA				TAP does not reduce the consumption of opioids in the first 24 h. TAP does not reduce VAS in the first 2 postoperative hours.
Atim et al., 2011³⁵	55	1 – TAP n 18 2 – placebo TAP n 18 3 – local infiltration n 19	+	+	+	+	+		NA		NA		TAP and infiltration reduce the pain score at rest and in movement at the hours 1, 2, 4, 6, 24 (p < 0.0001). TAP reduces the pain score at rest and in movement at the hours 6 and 24 regarding the infiltration (p < 0.001)
De Oliveira et al., 2011³⁶	75	1 – TAP 0.25% n 23 2 – TAP 0.5% n 24 3 – placebo TAP n 23	+	+	+	+	+	+	NA	NA	NA	NA	TAP improves the QoR-40 satisfaction score; average of 16 ropivacaine 0.5% and 17 ropivacaine 0.25% vs. saline (p < 0.05). There are no differences between ropivacaine 0.5% vs. ropivacaine 0.25%
Kane et al., 2012³⁷	56	1 – TAP n 28 2 – No TAP n 28								NA	NA	NA	TAP does not reduce the QoR-40 score or VAS scale. It does not reduce or increase the consumption of opioids
Aveline et al., 2011³⁸	275	1 – TAP n 132 2 – IHB n 139	+	+			+	+	NA	NA	NA	NA	TAP reduces the pain score at early (average 11 vs. 15; p = 0.04) and late (average 29 vs. 33; p = 0.013) rest. TAP reduces the mean consumption of opioids in the first 24 h; p = 0.03
López González et al., 2013³⁹	41	1 – TAP n 20 2 – local infiltration n 21					+	+	^a				Significant differences were not detected in VAS pain score between rest and movement. TAP reduces the mean consumption of opioids in the first 24 h (0.3 mg vs. 1.05 mg; p < 0.05)
Petersen et al., 2013⁴⁰	90	1 – TAP n 30 2 – Infiltration/IIB 30 3 – placebo TAP n 30	-		-	-							TAP does not reduce the pain score at rest or in movement in the first 24 h
Niraj et al., 2009⁴¹	52	1 – TAP n 25 2 – No TAP n 26	+	+	+	+			NA	+	NA	NA	TAP reduces the mean consumption of opioids in the first 24 h (28 mg vs. 50 mg; p < 0.002)
Hosgood et al., 2012⁴²	51	1 – TAP n 25 2 – placebo TAP n 25	+	+	+	+	+	+	+		NA		TAP reduces the mean consumption of opioids in the first 24 postoperative hours (12.4 mg vs. 21. 6 mg; p = 0.015). There is no significant difference in the cumulative consumption of opioids in the first 48 h
Parikh et al., 2013⁴³	60	1 – TAP n 30 2 – placebo TAP n 30	+		+		+	+	+		NA		TAP reduces the mean consumption of opioids in the first 24 h (103.8 ± 32.18 mg vs. 235.8 ± 47.5 mg)
Sinha et al., 2013⁴⁴	100	1 – TAP n 50 2 – placebo TAP n 50	+	+	+	+	+	+	NA			+	TAP reduces the mean consumption of opioids in the first 24 h (8 mg vs. 48 mg; p = 0.000)
Albrecht et al., 2013⁴⁵	70	1 – TAP n 25 2 – No TAP n 28											There are no differences between the consumption of opioids TAP and control in the first 4 postoperative hours (32.2 mg vs. 35.6 mg; p = 0.41)
Wu et al., 2013⁴⁶	90	1 – TAP n 29 2 – Epidural n 27 3 – Control n 26					-/+	-/+	NA				TAP is better than general anesthesia regarding the consumption of opioids in the first 24 h. Epidural is better than TAP regarding the consumption of opioids in the first 24 h
Elkassabany et al., 2013⁴⁷	52	1 – TAP n 16 2 – placebo TAP n 16	+	-	+	-	+	-	+	-	NA	NA	TAP reduces the mean consumption of opioids in the first 24 h (22.1 mg vs. 45.5 mg,)

Author, year	Type of block	Technique	Time	Needle	Anesthetic used by injection	Complications	Sensitive level of the block	Block duration	Additional analgesia	Conclusions
Niraj et al., 2011¹⁷	Bilateral	Subcostal	Postoperative	16 G 80 mm	1 mg kg^-1 bupivacaine 0.375%	No	No	NA	Paracetamol 1 g Tramadol 50–100 mg	There are no differences between VAS pain score at rest or in movement in the first 72 h, with TAP or epidural
Walter et al., 2013¹⁸	Bilateral	ND	Preoperative	ND	40 ml. Levobupivacaine 2 mg kg^-1 (maximum 150 mg)	No	No	NA	Paracetamol 1 g	TAP reduces in 33% the mean consumption of opioids in the first 24 h (20 mg), p < 0.05
Belavy et al., 2009¹⁹	Bilateral	Mid-axillary	Postoperative	20 G 150 mm	20 ml ropivacaine 0.5%	No	No	NA	Paracetamol 1 g Diclofenac 100 mg	TAP reduces the mean consumption of opioids in the first 24 h (13.5 mg), p < 0.05
Costello et al., 2009²⁰	Bilateral	Mid-axillary	Postoperative	20 G 64 mm	20 ml ropivacaine 0.375%	No	No	No	Ketorolac 30 mg Paracetamol 1.3 g rectal	TAP does not reduce VAS score in the first 24 h
Baaj et al., 2010²¹	Bilateral	Mid-axillary	Preoperative	20 G 100 mm	20 ml bupivacaine 0.25%	No	No	NA	No	TAP reduces the mean consumption of opioids in the first 24 h, (25.89 mg vs. 62 mg; p < 0.05)
Kanazi et al., 2010²²	Bilateral	Mid-axillary	Postoperative	21 G 100 mm	20 ml levobupivacaine 0.375 + adrenaline	No	No	NA	Paracetamol 1 g Diclofenac 100 mg	TAP extends 50% (TAP 8 h, MIT 4 h) of the time until the first opioid rescue, p < 0.05
Loane et al., 2012²³	Bilateral	Mid-axillary	Postoperative	22 G 80 mm	Ropivacaine 1.5 mg kg^-1 maximum 20 ml	No	No	NA	Naproxen 500 mg Paracetamol 1 g	TAP increases the mean consumption of opioids in the first 24 h, (7.5 mg vs. 2.7 mg; p = 0.03)
Tan et al., 2012²⁴	Bilateral	Mid-axillary	Postoperative	22 G 70 mm	20 ml levobupivacaine 0.25%	No	No	NA	Morphine chloride 0.15 mg kg^-1	TAP reduces the mean consumption of opioids in the first 24 h (12.3 mg vs. 31.4 mg; p < 0.01)
Bollag et al., 2012²⁵	Bilateral	Mid-axillary	Postoperative	20 G	20 ml ropivacaine 0.375%	No	No	NA	Paracetamol 1 g Diclofenac 75 mg Tramadol	To add clonidine to TAP with bupivacaine does not improve the wound hyperalgesia rate, and it does not improve the VAS score at rest and in movement
Eslamian et al., 2012²⁶	Bilateral	Mid-axillary	Postoperative	22 G 50 mm	15 ml bupivacaine 0.25%	No	No	NA	Diclofenac 100 mg	TAP reduces the VAS score at rest and in movement, as well as the consumption of opioids in the first 24 h (50 mg tramadol vs. 150 mg tramadol; p= 0.0001)
Cánovas et al., 2013²⁷	Bilateral	Mid-axillary	Postoperative	20 G	20 ml levobupivacaine 0.5%	No	No	NA	Morphine chloride	TAP reduces VAS at rest, 12/24 h (p < 0.05), and in movement (p ≤ 0.02)
Lee et al., 2013²⁸	Bilateral	Mid-axillary	Postoperative	21 G 90 mm	20 ml ropivacaine 0.5%	No	No	NA	Paracetamol 1 g Ketorolac 50 mg Morphine chloride	TAP reduces the pain score at rest and in movement in the first 2 postoperative hours (0.5 and 1.9 vs. 2.8 and 4.9; p < 0.001)
El-Dawlatly et al., 2009²⁹	Bilateral	Mid-axillary	Preoperative	21 G 90 mm	15 ml bupivacaine 0.5	No	No	NA	NA	TAP reduces the intraoperative consumption of sufentanil (p< 0.01) as well as the consumption of morphine in the first 24 h (12.3 mg; p < 0.05)
Ra et al., 2010³⁰	Bilateral	Mid-axillary	Preoperative	22 G 50 mm	15 ml bupivacaine 0.25% o 15 ml bupivacaine 0.5%	No	No	NA	Ketorolac 30 mg Fentanyl	TAP 0.25% and TAP 0.5% reduce the verbal-numerical pain score in the first 24 h (p < 0.001). There are no differences between TAP 0.25% and TAP 0.5%. TAP reduces the consumption of intraoperative remifentanyl as well as the use of postoperative analgesics (p < 0.001). There are no differences between TAP 0.25% and TAP 0.5%
L. Petersen et al., 2012³¹	Bilateral	Mid-axillary	Preoperative	22 G 80 mm	20 ml ropivacaine 0.5%	No	No	24 h	Paracetamol 1 g Ibuprofen 600 mg Morphine chloride	TAP reduces the VAS pain score movement, calculated as the area under the curve in the first 24 h (26 mm vs. 34 mm; p = 0.04)
Ortiz et al., 2012³²	Bilateral	Mid-axillary	Preoperative	21 G 100 mm	15 ml bupivacaine 0>,5%	No	No	NA	Ketorolac 30 mg	TAP does not reduce the VAS score in the first 24 h
Tolchard et al., 2012³³	Bilateral	Subcostal	Preoperative	22 G 100 mm	Bupivacaine 1 mg kg^-1 (average 22 ml)	No	No	NA	Codeine	TAP reduces VAS in the first 8 h (p < 0.01) TAP reduces the consumption of opioids in the first 8 h, (9.2 mg vs. 16.8 mg; p < 0.01)
Griffiths et al., 2010³⁴	Bilateral	Mid-axillary	Postoperative	90 mm	20 ml ropivacaine 0.5%	No	No	NA	Paracetamol 1 g, parecoxib 40 mg	TAP does not reduce the consumption of opioids in the first 24 h. TAP does not reduce VAS in the first 2 postoperative hours
Atim et al., 2011³⁵	Bilateral	Medial armpit	Preoperative	20 G 100 mm	20 ml bupivacaine 0.25%	No	No	NA	Diclofenac 75 mg Tramadol 0.5 mg kg^-1	TAP and infiltration reduce the pain score at rest and in movement at the hours 1, 2, 4, 6, 24 (p < 0.0001). TAP reduces the pain score at rest and in movement at the hours 6 and 24 regarding the infiltration (p < 0.001)
De Oliveira et al., 2011³⁶	Bilateral	Mid-axillary	Preoperative	21 G 90 mm	15 ml ropivacaine 0.25% o 0.5%	No	No	NA	Ketorolac 30 mg	TAP improves the QoR-40 satisfaction score; average 16 ropivacaine 0.5% and 17 ropivacaine 0.25% vs. saline; p < 0.05. There are no differences between ropivacaine 0.5% vs. ropivacaine 0.25%
Kane et al., 2012³⁷	Bilateral	NA	Postoperative	NA	20 ml ropivacaine 0.5% + adrenaline	No	No	NA	NA	TAP does not reduce QoR-40 score or VAS score. It does not reduce or increase the consumption of opioids
Aveline et al., 2011³⁸	Unilateral	Mid-axillary	Preoperative	22 G	1.5 mg kg^-1 levobupivacaine 0.5%	No	No	NA	Paracetamol 1 g Ketoprofen 100 mg	TAP reduces the pain score at early (average 11 vs. 15; p = 0.04) and late (average 29 vs. 33; p = 0.013) rest. TAP reduces the mean consumption of opioids in the first 24 h (p = 0.03)
López González et al., 2013³⁹	Unilateral	Mid-axillary	Preoperative	NA	30 ml bupivacaine 0.25%	No	No	NA	Paracetamol 1 g Dexketoprofen 50 mg Morphine chloride	Significant differences were not detected in VAS pain score between at rest and in movement. TAP reduces the mean consumption of opioids in the first 24 h (0.3 mg vs. 1.05 mg; p < 0.05)
Petersen et al., 2013⁴⁰	Unilateral	Mid-axillary	Preoperative	22 G 80 mm	25 ml ropivacaine 0.75%	No	No	NA	Ketebidona	TAP does not reduce the pain scale at rest or in movement in the first 24 h
Niraj et al., 2009⁴¹	Unilateral	Mid-axillary	Postoperative	23 G 60 mm	20 ml ropivacaine 0.5%	No	No	NA	Paracetamol 1 g Diclofenac 50 mg	TAP reduces the mean consumption of opioids in the first 24 h (28 mg vs. 50 mg; p < 0.002)
Hosgood et al., 2012⁴²	Unilateral	Mid-axillary	Preoperative	22 G	20 ml ropivacaine 0.375%	No	No	NA	Paracetamol 1 g Morphine chloride	TAP reduces the mean consumption of opioids in the first 6 postoperative hours (12.4 mg vs. 21.6 mg; p = 0.015). There is no significant difference in the cumulative consumption of opioids in the first 48 h
Parikh et al., 2013⁴³	Unilateral	Mid-axillary	Postoperative	18 G tohuy	25 ml bupivacaine 0.375%	No	No	NA	Diclofenac 1.5 mg kg^-1 Tramadol	TAP reduces the mean consumption of opioids in the first 24 h (103.8 ± 32.18 mg vs. 235.8 ± 47.5 mg)
Sinha et al., 2013⁴⁴	Bilateral	Modified mid-axillary	Postoperative	NA	20 ml ropivacaine 0.375%	No	No	No	NA	TAP reduces the mean consumption of opioids in the first 24 h (8 mg vs. 48 mg; p = 0.000)
Albrecht et al., 2013⁴⁵	Bilateral	Oblique subcostal	Preoperative	22 G 80 mm	30 ml bupivacaine 0.25% + adrenaline	No	No	No	Paracetamol 1 g Oxycodone 5–10 mg	There are no differences in the consumption of opioids between TAP and control in the first 24 postoperative hours (32.2 mg vs. 35.6 mg; p = 0.41)
Wu et al., 2013⁴⁶	Bilateral	Oblique subcostal	Preoperative	ND	20 ml ropivacaine 0.375%	No	No	No	Morphine chloride	TAP is better than general anesthesia regarding the consumption of opioids in the first 24 h. Epidural is better than TAP regarding the consumption of opioids in the first 24 h
Elkassabany et al., 2013⁴⁷	Bilateral	Mid-axillary	Postoperative	22 G	20 ml bupivacaine 0.5%	No	No	No	Morphine chloride	TAP reduces the mean consumption of opioids in the first 24 h (22.1 mg vs. 45.5 mg)

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Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
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[TFN01] LA, local anesthetic; IIB, ilioinguinal block; VAS, visual analog scale; ITM, intrathecal morphine; TAP, transverse abdominis plan.