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Systematic review and meta-analysis finds no difference between laparoscopic and ultrasound-guided TAP blocks for colorectal surgeryLap-TAPB offers same pain relief as ultrasound-guided block for colon surgery patients

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Key Takeaway
Consider that laparoscopic and ultrasound-guided TAP blocks show no significant difference in outcomes for laparoscopic colorectal surgery.

This is a systematic review and meta-analysis comparing laparoscopic-guided transversus abdominis plane block (Lap-TAPB) to ultrasound-guided transversus abdominis plane block (US-TAPB) in patients undergoing laparoscopic colorectal surgery. The analysis synthesized data from 585 patients.

The authors found no significant difference between the two techniques for the primary outcome of 24-hour postoperative opioid consumption (SMD −0.16; 95% CI = −0.39 to 0.08, p = 0.20). Similarly, no significant differences were observed for pain scores at 24 hours at rest (SMD −0.17; 95% CI = −0.39 to 0.04, p = 0.12), incidence of postoperative nausea and vomiting (OR = 0.97; 95% CI = 0.36–2.65, p = 0.96), operative time (SMD 0.05; 95% CI = −0.19 to 0.30, p = 0.67), or complications (OR = 1.25; 95% CI = 0.77–2.03, p = 0.37).

The authors noted that previous meta-analyses were constrained by small sample sizes and lacked integration of emerging evidence from recent randomized controlled trials. Safety data, including adverse events, were not reported in the source.

The authors suggest that Lap-TAPB eliminates the need for ultrasound devices and may decrease logistical complexity. However, the findings are based on a synthesis of existing trials and do not establish superiority or equivalence definitively. Clinicians should interpret these results in the context of the available evidence, which indicates no clear advantage for either technique.

Patients getting colon surgery often face a tough choice between different pain management techniques. One method uses ultrasound to guide a nerve block, but it requires special equipment. Another method uses a laparoscopic camera to guide the same block, potentially simplifying the process. A new analysis looked at 585 patients to see if this simpler approach actually worked differently.

The review compared pain relief, nausea, and safety between the two methods. The results showed no meaningful difference in how much pain medicine people needed, how much pain they felt, or how often they got nausea and vomiting. The time spent in surgery and the rate of complications were also the same for both groups.

While this analysis brings together recent trial data to fix older studies that were too small, it does not prove one method is better. It does, however, suggest that using a camera instead of ultrasound does not hurt patient outcomes. This could help hospitals reduce the need for expensive ultrasound devices without risking patient comfort or safety.

What this means for you:
Using a camera instead of ultrasound for pain blocks during colon surgery works just as well.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BackgroundTransversus abdominis plane block (TAPB) has become a fundamental component of multimodal analgesia for laparoscopic colorectal surgery. Previous meta-analyses comparing laparoscopic-guided TAPB (Lap-TAPB) with ultrasound-guided TAPB (US-TAPB) were constrained by small sample sizes and lacked integration of emerging evidence from recent randomized controlled trials (RCTs). Given the increasing number of studies published since 2023, an updated review is warranted.ObjectivesTo conduct an updated systematic review and meta-analysis comparing Lap-TAPB with US-TAPB in terms of analgesic efficacy and perioperative outcomes in patients undergoing laparoscopic colorectal surgery.MethodsPubMed, Embase, and Web of Science were searched, from their inception until November 2025, for studies evaluating Lap-TAPB versus US-TAPB and reporting postoperative analgesic or clinical outcomes following the PRISMA guidelines. The primary outcome was 24-h postoperative opioid consumption, whereas the secondary outcomes included pain scores at 24 h (at rest), postoperative nausea and vomiting (PONV), operative time and complications.ResultsFive studies involving 585 patients were included in this review. No significant differences were observed in 24-h postoperative opioid consumption with Lap-TAPB (standardized mean difference (SMD) −0.16, 95% confidence interval (CI) = −0.39 to 0.08, p = 0.20), pain scores at rest at 24 h (SMD −0.17, 95% CI = −0.39 to 0.04, p = 0.12), incidence of PONV (odds ratio (OR) = 0.97, 95% CI = 0.36–2.65, p = 0.96), operative time (SMD 0.05, 95% CI = −0.19 to 0.30, p = 0.67), and complications (OR = 1.25, 95% CI = 0.77–2.03, p = 0.37).ConclusionLap-TAPB did not result in significantly lower 24-h postoperative opioid consumption, pain scores at 24 h (at rest), PONV incidence, operative time and complications compared to US-TAPB. However, it eliminates the need for ultrasound devices while decreasing the logistical complexity of the procedure.
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