The efficacy of different nerve blocks on postoperative pain and sequela in patients undergoing abdominoplasty: a network meta-analysis.

BACKGROUND
Although abdominoplasty is growing in popularity, it is still encumbered with considerable postoperative pain, which prolongs recovery.


OBJECTIVES
Aim of this network meta-analysis is to combine the evidence from different regional nerve blocks and examine their effectiveness in the management of postoperative pain sequela and recovery following abdominoplasty.


METHODS
An electronic literature search in MEDLINE (PubMed, National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), the Cochrane Library (London, United Kingdom) and US National Institutes of Health Ongoing Trials Register electronic databases (Bethesda, MD) was conducted from inception to July 2022. Inclusion criteria were the presence of intervention and control groups, data derived from controlled studies evaluating nerve blocks after abdominoplasty, in terms of analgesia needs, complications, and patient satisfaction, and publication in peer-reviewed journals. The quality of studies was assessed via Cochrane's risk of bias tool. A frequentist random effects network meta-analysis was conducted for all outcomes of interest.


RESULTS
A total of 12 studies met the inclusion criteria containing 543 patients with no differences in age, sex, BMI and comorbidities. Transversus abdominis plane block (TAP) blocks have been found to reduce 24h, and 48h opioid consumption (-3.70 weighted mean differences [WMD] and -5.01 WMD, respectively). Also, the nerve blocks reviewed effectively prolonged the time to first rescue analgesia request, were safe, in terms of complications, and were associated with high satisfaction rates.


CONCLUSIONS
Nerve blocks emerge as an effective and safe adjunct for adequate pain management following abdominoplasty. This meta-analysis provides an evidence-based strategy to optimize the current analgesia regimens following abdominoplasty.