Korean J Anesthesiol.  2023 Feb;76(1):34-46. 10.4097/kja.22366.

Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis

Affiliations
  • 1UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
  • 2Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
  • 3Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
  • 4Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
  • 5Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
  • 6UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy

Abstract

Background
Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach.
Methods
We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials.
Results
A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (−1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (−1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV.
Conclusions
RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.

Keyword

Cholecystectomy; Laparoscopic cholecystectomy; Laparoscopic surgery; Local anesthesia; Meta-analysis; Regional anesthesia

Cited by  2 articles

Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial
Hye-Yeon Cho, In Eob Hwang, Mirang Lee, Wooil Kwon, Won Ho Kim, Ho-Jin Lee
Korean J Pain. 2023;36(3):382-391.    doi: 10.3344/kjp.23114.

Response to "Comment on Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis"
Alessandro De Cassai, Federico Geraldini
Korean J Anesthesiol. 2024;77(3):406-407.    doi: 10.4097/kja.23703.

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