The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis.

[BACKGROUND] Although abdominoplasty is growing in popularity, it still results in considerable postoperative pain, which prolongs recovery.

[OBJECTIVES] The aim of this network meta-analysis was to combine evidence about different regional nerve blocks to examine their effectiveness in the management of postoperative pain sequelae and recovery following abdominoplasty.

[METHODS] An electronic literature search in the MEDLINE (PubMed; National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), Cochrane Library (London, UK) 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, containing 543 patients with no differences in age, sex, BMI, and comorbidities, met the inclusion criteria. Transversus abdominis plane blocks have been found to reduce 24-hour and 48-hour opioid consumption (-3.70 and -5.01 weighted mean difference, respectively). In addition, 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.