Comparing the analgesic effect of regional nerve block technique in laparoscopic nephrectomy: A systematic review and...

Various regional nerve block techniques have been employed to manage acute pain following laparoscopic nephrectomy; however, the optimal technique remains unclear.

This network meta-analysis (NMA) compares the analgesic efficacy of various regional nerve block techniques. We conducted a comprehensive search in PubMed, Embase, Web of Science (WOS), Cochrane, and Scopus databases from inception until October 10, 2024, for randomized controlled trials (RCTs) that compare the analgesic efficacy of regional nerve block techniques, including quadratus lumborum block (QLB), transversus abdominis plane block (TAPB), retrolaminar block (RLB), local infiltration anesthesia (LIA), erector spinae block (ESB), paravertebral block (PVB), and epidural analgesia) for post-laparoscopic nephrectomy pain management. The entire NMA analysis was conducted using R software and a Bayesian framework. The primary outcome of this NMA was the cumulative oral morphine equivalent (OME) consumption at 24 h postoperatively. Secondary outcomes included 6-h postoperative OME consumption, intraoperative OME consumption, time to first opioid use, incidence of rescue analgesic use, incidence of nausea and vomiting, and patient satisfaction.

Our direct comparison results indicate that the interventions effectively reduced OME consumption at 24 h and 6 h postoperatively and intraoperatively, extended the time to first opioid use, improved patient satisfaction, and reduced the incidence of postoperative nausea and vomiting. The NMA results demonstrated that preoperative quadratus lumborum block (PreOp QLB; MD -31.23, 95 % CI -54.99 to -9.95; low-quality evidence) and preoperative erector spinae block (PreOp ESB; MD -44.44, 95 % CI -88.03 to -0.97; moderate-quality evidence) significantly reduced the 24-h postoperative OME consumption.

Analysis of existing evidence suggests that PreOp QLB demonstrates a superior advantage over other interventions, significantly reducing 24-h postoperative OME, 6-h postoperative OME, rescue analgesia usage, and the incidence of postoperative nausea and vomiting, as well as extending time to first opioid use. Other interventions, such as PreOp ESB, also show potential benefits. However, due to limitations in the current number of studies and sample sizes, future large-scale, high-quality studies are necessary to further support these findings.