Regional Analgesia in Pediatric Cardiothoracic Surgery: A Bayesian Network Meta-Analysis

Various regional analgesia techniques are used to reduce postoperative pain in pediatric patients undergoing cardiothoracic surgeries. This study aimed to determine the relative efficacy of regional analgesic interventions. PubMed, EMBASE, Web of Science, and Cochrane databases were searched to identify all randomized controlled studies evaluating the effects of regional block after cardiothoracic surgery. The primary endpoint was opioid consumption within 24 hours postoperatively, Pain scores, the time to first rescue analgesic, and the incidence of postoperative nausea and vomiting were also collected. A Bayesian NMA was performed to compare the outcomes of interest. A total of 24 studies involving 1602 patients and 13 regional blocks were included. All techniques reduced opioid consumption within 24 hours postoperatively. The largest decrease was in the thoracic retrolaminar block group, with a WMD of -0.97 (95% CrI -1.1, -0.84) mg/kg morphine equivalent. In terms of pain scores, there was no significant difference between any block and the control at any time point except for the thoracic retrolaminar block group at 0 hours postoperatively. In addition, all regional blocks prolonged the time to first rescue analgesic, which was the longest in the pectoral nerve block group. The incidence of postoperative nausea and vomiting was the lowest in the epidural anesthesia group, followed by the transversus thoracis muscle plane block group. Regional anesthesia revealed significant opioid-sparing effects following pediatric cardiothoracic surgery. However, indirect comparisons are limited because of the heterogeneity of previous studies, and direct comparisons are needed to establish the relative efficacies of different blocks.