A meta-analysis of laparoscopic versus ultrasound-guided transversus abdominis plane block in laparoscopic colorectal surgery

BACKGROUND

Enhanced recovery programmes in laparoscopic colorectal surgery (LCS) employ combined approaches to achieve postoperative analgesia. Transversus abdominis plane (TAP) block is a locoregional anaesthetic technique that may reduce postoperative pain.

AIMS

To perform a systematic review and meta-analysis to compare the effectiveness of laparoscopic- versus ultrasound-guided TAP block in LCS.

METHODS

Databases were searched for relevant articles from inception until March 2022. All randomised controlled trials (RCTs) that compared laparoscopic (LTB) versus ultrasound-guided (UTB) TAP blocks in LCS were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included pain scores at 24 h postoperatively, operative time, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates.

RESULTS

Three RCTs were included capturing 219 patients. Studies were clinically heterogenous. On random effects analysis, LTB was associated with significantly lower narcotic consumption (SMD - 0.30 mg, 95% CI = - 0.57 to - 0.03, p = 0.03) and pain scores (SMD - 0.29, 95% CI = - 0.56 to - 0.03, p = 0.03) at 24 h. However, there were no differences in operative time (SMD - 0.09 min, 95% CI = - 0.40 to 0.22, p = 0.56), PONV (OR = 0.97, 95% CI = 0.36 to 2.65, p = 0.96) or complication (OR = 1.30, 95% CI = 0.64 to 2.64, p = 0.47) rates.

CONCLUSIONS

LTB is associated with significantly less narcotic usage and pain at 24 h postoperatively but similar PONV, operative time and complication rates, compared to UTB. However, the data were inconsistent, and our findings require further investigation. LTB obviates the need for ultrasound devices whilst also decreasing procedure logistical complexity.

The Quality of Otology and Neurotology Research in Otology Journals

OBJECTIVE

To establish the level of evidence and publishing trends in otology-specific journals over a 20-year period.

DESIGN

Retrospective analysis.

METHODS

The three O/N specific journals with the highest Eigenfactor scores were identified. All articles published in the years 1998, 2008, and 2018 were reviewed and level of evidence (LoE) based on standards set by the Oxford Centres for Evidence Based Medicine was assigned by two independent reviewers. One way analysis of variance and 95% bootstrap sensitivity analysis were performed.

RESULTS

A total of 1,062 studies were published over 20 years, of these 809 (76.2%) were eligible for inclusion in the present study. The average number of publications per year increased over time. The average LoE improved significantly over the total interval (-0.235, p = 0.027, [CI -0.45, -0.019]), however did not between 1998 and 2008 (p = 0.111) or between 2008 and 2018 (p = 1). When looking at just LoE 1 or 2, the number and percentage of higher quality papers improves over time-48/158 (30.4%) in 1998, rising to 94/250 (37.6%) in 2008, and 158/401 (39.4%) in 2008.

CONCLUSIONS

Over the past two decades there has been an overall increase in the quantity and quality (as measured by LoE) of publications in O/N-specific journals. In general, quality of O/N studies is slightly better in O/N-specific journals compared with general OHNS journals. However, there are still improvements to be had in the proportion of high-evidence publications, as they still number less than half of all total publications in the subspecialty.