James K Hamill1, Jamie-Lee Rahiri2, Andrew Liley1, Andrew G Hill2. 1. Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand. 2. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Abstract
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.
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.
Authors: T Steinfeldt; P Kessler; O Vicent; U Schwemmer; J Döffert; P Lang; D Mathioudakis; E Hüttemann; W Armbruster; S Sujatta; M Lange; S Weber; F Reisig; R Hillmann; T Volk; T Wiesmann Journal: Anaesthesist Date: 2020-12 Impact factor: 1.041