Preemptive regional nerve blocks for sternotomy in pediatric cardiac surgery: a Bayesian network metaanalysis
Bloqueios nervosos regionais preemptivos para esternotomia em cirurgia cardíaca pediátrica: uma meta-análise em rede bayesiana
Bruno F.M. Wegner, Gustavo R.M. Wegner, Jaime A. Arias, Tatiana S. Nascimento
Abstract
Background
Effective pain management and expedited recovery are critical in pediatric cardiac surgery. While regional anesthesia techniques provide targeted pain control and may reduce opioid use and related complications, comparative evidence among regional nerve blocks in this population is limited. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.
Methods
We conducted a Bayesian Network Meta-Analysis (NMA) including Randomized Controlled Trials (RCTs) of pediatric patients (0−12 years) undergoing cardiac surgery by sternotomy and receiving preemptive regional nerve blocks. Primary outcomes included pain scores, opioid consumption and extubation time. Both direct and indirect evidence were synthesized to rank interventions probabilistically. This study was registered on PROSPERO (CRD42024585785) and followed PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions.
Results
The NMA incorporated 12 RCTs, comprising 969 participants, and evaluated seven regional nerve blocks. Among the techniques studied, transversus Thoracis Muscle Plane Block (TTPB) consistently ranked among the most effective for pain relief and recovery. Other blocks, including thoracic retrolaminar block and thoracic paravertebral block, also demonstrated notable performances. Adverse events were infrequent but inconsistently reported, preventing an adequate analysis.
Conclusion
This NMA identified TTPB as a consistently top-performing technique across outcomes. These findings provide promising support for its inclusion in ERAS protocols, although further high-quality trials are needed.
Registration
PROSPERO ID: CRD42024585785.
Keywords
Resumo
Introdução
O manejo eficaz da dor e a recuperação acelerada são fundamentais na cirurgia cardíaca pediátrica. Embora as técnicas de anestesia regional ofereçam controle de dor direcionado e possam reduzir o uso de opioides e suas complicações associadas, as evidências comparativas entre bloqueios nervosos regionais nessa população ainda são limitadas. Este estudo teve como objetivo realizar uma revisão sistemática e meta-análise em rede para apoiar a tomada de decisão clínica quanto à analgesia ideal.
Métodos
Realizou-se uma meta-análise em rede bayesiana (NMA) incluindo ensaios clínicos randomizados (RCTs) com pacientes pediátricos (0–12 anos) submetidos à cirurgia cardíaca por esternotomia e que receberam bloqueios nervosos regionais preemptivos. Os desfechos primários incluíram escores de dor, consumo de opioides e tempo até a extubação. Foram sintetizadas evidências diretas e indiretas para classificar probabilisticamente as intervenções. Este estudo foi registrado no PROSPERO (CRD42024585785) e seguiu a extensão PRISMA para relatos de revisões sistemáticas que incorporam meta-análises em rede de intervenções em saúde.
Resultados
A NMA incorporou 12 RCTs, totalizando 969 participantes, e avaliou sete tipos de bloqueios nervosos regionais. Entre as técnicas estudadas, o Bloqueio do Plano do Músculo Transverso do Tórax (TTPB) classificou-se consistentemente entre os mais eficazes para alívio da dor e recuperação. Outros bloqueios, incluindo o bloqueio retrolaminar torácico e o bloqueio paravertebral torácico, também apresentaram desempenho relevante. Eventos adversos foram pouco frequentes, mas relatados de forma inconsistente, o que impediu uma análise adequada.
Conclusão
Esta NMA identificou o TTPB como uma técnica com desempenho consistentemente superior nos desfechos avaliados. Esses achados oferecem suporte promissor para sua inclusão em protocolos ERAS, embora sejam necessários estudos adicionais de alta qualidade.
Registro
PROSPERO ID: CRD42024585785.
Palavras-chave
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Submitted date:
03/11/2025
Accepted date:
06/08/2025
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