Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials
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 sear...
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| Veröffentlicht in: | Pediatric anesthesia 2016-04, Vol.26 (4), p.363-371 |
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| creator | Hamill, James K. Rahiri, Jamie-Lee Liley, Andrew Hill, Andrew G. |
| description | 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. |
| doi_str_mv | 10.1111/pan.12855 |
| format | Article |
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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.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.12855</identifier><identifier>PMID: 26846889</identifier><language>eng</language><publisher>France: Blackwell Publishing Ltd</publisher><subject>Abdominal Wall ; child ; Humans ; meta-analysis ; nerve block ; Nerve Block - methods ; pediatrics ; postoperative pain ; Randomized Controlled Trials as Topic ; Rectus Abdominis ; regional anesthesia</subject><ispartof>Pediatric anesthesia, 2016-04, Vol.26 (4), p.363-371</ispartof><rights>2016 John Wiley & Sons Ltd</rights><rights>2016 John Wiley & Sons Ltd.</rights><rights>Copyright © 2016 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4615-aa95508e5f079769d15ccb7dd9f0927b31f02053b9f4fddcad5d4219aedcdcfd3</citedby><cites>FETCH-LOGICAL-c4615-aa95508e5f079769d15ccb7dd9f0927b31f02053b9f4fddcad5d4219aedcdcfd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.12855$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.12855$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26846889$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lonnqvist, Per-Arne</contributor><contributor>Lonnqvist, Per‐Arne</contributor><creatorcontrib>Hamill, James K.</creatorcontrib><creatorcontrib>Rahiri, Jamie-Lee</creatorcontrib><creatorcontrib>Liley, Andrew</creatorcontrib><creatorcontrib>Hill, Andrew G.</creatorcontrib><title>Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>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.</description><subject>Abdominal Wall</subject><subject>child</subject><subject>Humans</subject><subject>meta-analysis</subject><subject>nerve block</subject><subject>Nerve Block - methods</subject><subject>pediatrics</subject><subject>postoperative pain</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rectus Abdominis</subject><subject>regional anesthesia</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9rFDEUx4MotlYP_gMS8KKHaZPMZDLxVou2xaWKKIKX8CZ5YdPOj20y07riH292t-1BMJcXwud9Hi9fQl5ydsjzOVrBcMhFI-Ujss-rmhVaavE437mUhawruUeepXTJGC9FLZ6SPVE3Vd00ep_8-Yp2mhNNS4RpSWFwdIowpBuMKT9D68Y-DCHRVQcD0rYb7VWiYaB2GToXcXhHgaZ1mrCHKVga8Sbg7dbT4wQFDNCtU-4fPc3eje03bmYE6NJz8sTngi_u6gH5_vHDt5OzYvH59PzkeFHYquayANBSsgalZ0qrWjsurW2Vc9ozLVRbcs8Ek2WrfeWds-CkqwTXgM466115QN7svKs4Xs-YJtOHZLHbrDTOyXClBK-kanhGX_-DXo5zzEtsKV5mr6wz9XZH2TimFNGbVQw9xLXhzGwiMTkSs40ks6_ujHPbo3sg7zPIwNEOuA0drv9vMl-OL-6Vxa4j5H__9dAB8crUqlTS_Lg4NfL9pwUX5U9TlX8BIFCmrQ</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Hamill, James K.</creator><creator>Rahiri, Jamie-Lee</creator><creator>Liley, Andrew</creator><creator>Hill, Andrew G.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials</title><author>Hamill, James K. ; Rahiri, Jamie-Lee ; Liley, Andrew ; Hill, Andrew G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4615-aa95508e5f079769d15ccb7dd9f0927b31f02053b9f4fddcad5d4219aedcdcfd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Wall</topic><topic>child</topic><topic>Humans</topic><topic>meta-analysis</topic><topic>nerve block</topic><topic>Nerve Block - methods</topic><topic>pediatrics</topic><topic>postoperative pain</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rectus Abdominis</topic><topic>regional anesthesia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamill, James K.</creatorcontrib><creatorcontrib>Rahiri, Jamie-Lee</creatorcontrib><creatorcontrib>Liley, Andrew</creatorcontrib><creatorcontrib>Hill, Andrew G.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamill, James K.</au><au>Rahiri, Jamie-Lee</au><au>Liley, Andrew</au><au>Hill, Andrew G.</au><au>Lonnqvist, Per-Arne</au><au>Lonnqvist, Per‐Arne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2016-04</date><risdate>2016</risdate><volume>26</volume><issue>4</issue><spage>363</spage><epage>371</epage><pages>363-371</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><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><cop>France</cop><pub>Blackwell Publishing Ltd</pub><pmid>26846889</pmid><doi>10.1111/pan.12855</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Abdominal Wall child Humans meta-analysis nerve block Nerve Block - methods pediatrics postoperative pain Randomized Controlled Trials as Topic Rectus Abdominis regional anesthesia |
| title | Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials |
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