- Design
- Systematic review with Bayesian random-effects and network meta-analysis
- Population
- 903 adult kidney transplant recipients in 14 randomised trials
- Primary outcome
- Pain scores and 24-hour opioid consumption against MCID
- Effect
- 24-h opioids: QL −15.5 MME (−23.6 to −6.7); TAP −10.5 MME (−14.4 to −5.5)
A systematic review and Bayesian meta-analysis included 14 randomised trials of regional analgesia in 903 adult kidney transplant recipients, judging effects against minimal clinically important differences: 1 point for pain and 5 mg morphine equivalents for opioid use.
Only quadratus lumborum (QL) and transversus abdominis plane (TAP) blocks had enough trials to pool. Both lowered pain at every time point, but no comparison had a high probability of exceeding the 1-point threshold. Opioid use at 24 hours fell by 15.5 morphine milligram equivalents with QL (95% credible interval −23.6 to −6.7) and 10.5 with TAP (−14.4 to −5.5), each with over 97% probability of being clinically important. Neither block was clearly better than the other.
Certainty was very low, 12 registered trials were unpublished, and graft function and safety were too sparsely reported to pool. Opioid sparing matters in recipients whose new kidney may clear drugs unpredictably, so a fascial plane block is a reasonable part of a multimodal plan, but choice between QL and TAP can rest on local skill.
- Consider a QL or TAP block as part of multimodal analgesia for kidney transplant recipients.
- Choose between QL and TAP on local expertise; the network analysis found no clear winner.
- Expect opioid sparing more than a large pain-score difference.
- Continue to monitor graft function closely; no trial data show the blocks affect it either way.
Why it matters
Graft function limits systemic analgesia, so a block that spares opioids has particular value in this group.
Don't overread it
Very low certainty, with many unpublished trials and no pooled graft or safety data.
The statistics, in plain English
A credible interval of −23.6 to −6.7 means the true opioid reduction with QL most plausibly lies in that range. A greater than 97% probability of exceeding 5 mg means the benefit is very likely large enough to matter; for pain scores, it was not.
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