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Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized
James K Hamill1, Jamie-Lee Rahiri2, Andrew Liley1
1Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.
Insights
Rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks effectively reduce postoperative pain and opioid use in children undergoing abdominal surgery. Further research is needed due to study heterogeneity.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- The efficacy of rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks in pediatric surgical settings remains incompletely defined.
- Establishing the role of these nerve blocks is crucial for optimizing postoperative care in children.
Purpose of the Study:
- To evaluate the impact of RSB and TAP blocks on postoperative pain and recovery in pediatric patients.
- To synthesize evidence from randomized trials regarding the effectiveness of these abdominal wall blocks.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searches were performed across multiple databases including MEDLINE, EMBASE, Cochrane, and Web of Science.
- Data extraction and quality assessment were performed independently by two reviewers for included trials.
Main Results:
- Ten RCTs involving 599 pediatric patients were included.
- Nerve blocks demonstrated a reduction in morphine requirements and lower pain scores post-surgery.
- Time to first rescue analgesia was significantly delayed, though some studies had moderate to high risk of bias.
Conclusions:
- Abdominal wall blocks, including RSB and TAP blocks, are effective in reducing pain and opioid consumption in children.
- Results should be interpreted with caution due to significant heterogeneity among the included studies.
Introduction:
The role of rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks in pediatric surgery has not been well established.
Objective:
We aimed to determine if RSB and TAP blocks decrease postoperative pain and improve recovery in children.
Data Sources:
Duplicate searching of MEDLINE, EMBASE, Cochrane, Web of Science, and trial registries databases by two reviewers.
Study Selection:
Included were randomized trials in children on RSB or TAP block in abdominal operations, excluding inguinal procedures.
Data Extraction:
Independent duplicate data extraction and quality assessment using a standardized form.
Results:
Ten trials met inclusion criteria (n = 599), RSB in five and TAP block in five. A linear mixed effects model on patient level data from three trials showed nerve blocks lowered morphine requirements 6-8 h after surgery, -0.03 mg · kg(-1) (95% CI -0.05, -0.002). Pooled analysis of summary data showed nerve blocks lowered 0-10 scale pain scores immediately after the operation, -0.7 (95% CI -1.3, -0.1); lowered 4-16 scale pain scores, -2.0 (95% CI -2.3, -1.7); and delayed the time to first rescue analgesia, 17 min (95% CI 1.3, 33). Quality assessment showed some studies at moderate to high risk of bias.
Conclusion:
Abdominal wall blocks reduce pain and opiate use in children. We advise cautious interpretation of the results given the heterogeneity of studies.
