title: Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Duplicate searching of MEDLINE, EMBASE, Cochrane, Web of Science, and trial registries databases by two reviewers.
  
  
  METHODS
  Included were randomized trials in children on RSB or TAP block in abdominal operations, excluding inguinal procedures.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Abdominal wall blocks reduce pain and opiate use in children. We advise cautious interpretation of the results given the heterogeneity of studies.
authors: Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.
authors: James K
authors: JK
authors: Hamill
authors: Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors: Jamie-Lee
authors: JL
authors: Rahiri
authors: Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.
authors: Andrew
authors: A
authors: Liley
authors: Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors: Andrew G
authors: AG
authors: Hill
mesh_terms: D034861:Abdominal Wall; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D017568:Rectus Abdominis
keywords: child; meta-analysis; nerve block; pediatrics; postoperative pain; regional anesthesia