Work

Adjuvants in transversus abdominis plane blocks to prolong analgesia duration following cesarean delivery: A systematic review and network meta-analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: Various adjuvants can be added to local anesthetics (LAs) to prolong the duration of regional anesthesia. This network meta-analysis (NMA) aimed to compare the relative efficacy of commonly used adjuvants in transversus abdominis plane (TAP) blocks following cesarean delivery (CD). METHODS: A comprehensive literature search was performed in PubMed, Embase, CENTRAL, web of science, and Wanfang data. Eligible studies were randomized controlled trials comparing the effects of adding an adjuvant to LA versus LA alone or versus another adjuvant in a single-shot TAP block after CD. The primary outcome was time to first analgesia request. Bayesian random-effects NMAs were performed using the LA alone group as the comparator. RESULTS: Thirty-nine studies involving five adjuvants were included. None of the studies administered intrathecal morphine. Compared to LA alone, time to first analgesic request was significantly prolonged with clonidine (6.9 h, 95 % CrI 4.5-9.4 h), dexamethasone (5.8 h, 95 % CrI 4.2-7.4 h), dexmedetomidine (4.1 h, 95 % CrI 2.7-5.5 h) and magnesium sulfate (3.2 h, 95 % CrI 0.9-5.7 h). Clonidine ranked first, followed by dexamethasone, dexmedetomidine, and magnesium. However, in the outlier analysis and the subgroup analysis of women receiving basic analgesics, dexamethasone ranked first, while magnesium was ineffective. Overall, adjuvants had minimal clinical impact on postoperative opioid consumption or pain scores. Notably, high heterogeneity was observed, and the quality of evidence was rated as low or very low. CONCLUSIONS: With the high heterogeneity and the low or very low quality of the evidence, clonidine, dexamethasone, and dexmedetomidine may prolong analgesia after CD without intrathecal morphine when used as adjuvants in TAP blocks. Furthermore, dexamethasone and dexmedetomidine appear preferable when basic analgesics are administered. Nevertheless, these results should be interpreted with caution.

Source: Journal of Clinical Anesthesia

DOI: 10.1016/j.jclinane.2025.112067

Authors: Li-Zhong Wang, Jia-Yue Huang, Xiang-Yang Chang, Feng Xia

Institution: Jiaxing University

Language: English

Topic: Anesthesia and Pain Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,090