Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta‐analysis of randomized trials. Issue 4 (4th February 2016)

• Record Type: Journal Article
• Authors: Hamill, James K.; Rahiri, Jamie‐Lee; Liley, Andrew; Hill, Andrew G.
• Editors: Lonnqvist, Per‐Arne
• Is Part Of: Paediatric anaesthesia. Volume 26:Issue 4(2016:Apr.)
• Page Start: 363
• Page End: 371
• Publication Date: 2016-02-04
• Subjects: nerve block -- regional anesthesia -- postoperative pain -- child -- pediatrics -- meta‐analysis; Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12855
• Languages: English
• ISSNs: 1155-5645

Abstract

Summary: 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. Abstract :