Regional analgesic techniques for postoperative pain after kidney transplantation: a systematic review and Bayesian meta-analysis

Br J Anaesth. 2026 Oct 27:S0007-0912(26)00738-5. doi: 10.1016/j.bja.2026.09.018. Online ahead of print.

ABSTRACT

BACKGROUND: Pain after kidney transplantation is often severe, and graft function constrains the use of systemic analgesia. Previous syntheses of regional techniques pooled them as a class, combined donors with recipients, and did not use a minimal clinically important difference (MCID).

METHODS: We searched PubMed, Embase, and CENTRAL through 5 September 2026 for randomised trials of regional analgesia in adult kidney transplant recipients (PROSPERO CRD420261478933); a trial-registry search and network meta-analysis were added post hoc. Bayesian random-effects models with MCID-scaled priors yielded posterior probabilities of benefit and of exceeding the MCID, and certainty of evidence was assessed using the GRADE framework.

RESULTS: Fourteen trials (903 participants) were included. Only quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks could be pooled against control. Both yielded lower pain at every pooled time point, but no pairwise pain comparison reached 80% probability of exceeding the 1.0 point MCID. Opioid consumption at 24 h was lower with the QL block (-15.5 morphine milligram equivalents; 95% credible interval -23.6 to -6.7) and the TAP block (-10.5; -14.4 to -5.5), with each reduction exceeding the 5 mg MCID with a probability >97%. In the network meta-analysis, no difference between QL and TAP blocks in pain or opioid consumption reached 80% probability of exceeding the MCID. Graft function and safety data were too sparse to pool. Twelve eligible registered trials were unpublished; certainty of evidence was very low.

CONCLUSIONS: Quadrtus lumborum and transversus abdominus plane blocks reduce pain and opioid consumption at 24 h, but only the reduction in opioid consumption has a high probability of being clinically important. Certainty of evidence is very low; no technique is preferred, and effects on graft function are unknown.

PMID:42946571 | DOI:10.1016/j.bja.2026.09.018