16 June 2026 : Database Analysis
Opioid-Sparing Effects of Peripheral Nerve Blocks in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis
Hye Joo Yun ABCDEF 1, Dong Hyun Kim CDEF 1, Mee Young Chung ABCDEFG 1, Ji Young Min
ABCDEF 1*
DOI: 10.12659/AOT.952211
Ann Transplant 2026; 31:e952211
Table 1 Summary of included studies evaluating peripheral nerve blocks for postoperative analgesia in adult kidney transplant recipients.
| Study | n | Patients | Groups (n) | Primary outcome | Study design | Local anesthetics, volume and concentration, adjuvants | Postoperative analgesia |
|---|---|---|---|---|---|---|---|
| Shoeibi et al []16 | 42 | All | IG–IH + intercostal (21) vs Control (21) | 24 hr morphine consumption | RCT (single-blind) | Bupivacaine 0.5% (4 mL ×3 sites + epi 5 μg per syringe) | ↓ VAS (all time points 1–24 h median 1 vs 4–6 controls); ↓ 24 h morphine (12.7±10.5 vs 34.9±5.9 mg); no block complication |
| Mukhtar et al []17 | 20 | All | TAP (10) vs Control (10) | 24 hr morphine consumption) | Pilot study | Bupivacaine 0.5% 20 mL (single injection post-induction) | TAP group; ↓ morphine use (10.4±4.5 vs 28.9±7.1 mg); VAS ↓ at 3,6,12 h; less nausea & sedation at 3, 6 hr |
| Freir et al []18 | 65 | DDKT | TAP (32) vs Control (33) | Opioid consumption /pain | RCT (double-blind) | Levobupivacaine 0.375% 20 mL (landmark technique) | No difference in 24 h morphine (31.6 vs 32.6 mg); VAS no difference; nausea ↑ in TAP group (53% vs 24%) |
| Mohammadi et al []19 | 44 | All | TAP (22) vs Control (22) | 24 hr morphine consumption (and NRS) | RCT (double-blind) | Bupivacaine 0.25% 15 mL + epi 5 μg/mL (US-guided single-shot) | ↓ morphine (10.8±9.5 vs 41.2±3.8 mg); NRS ↓ at 1–24 h (all <0.001); no block complication |
| Khaled MA et al []20 | 60 | All | TAP (30) vs Control (30) | 24 hr morphine consumption and VAS | RCT (open label) | Bupivacaine 0.5% 20 mL (pre-incisional, US-guided) | ↓ intra-op fentanyl (367.5 vs 426.3 μg); ↓ PACU morphine (3.7 vs 6.6 mg); ↓ 24 h dose (27.8 vs 42.6 mg); VAS ↓ at 6, 24 h |
| Gopwani SR et al []21 | 50 | All | TAP (13) vs Control (37) | 24 hr morphine consumption | Retrospective chart review | Bupivacaine 0.25% 20 mL (US-guided, TAP plane injection) | Median morphine ↓ at 6 h (2.46 vs 7.27 mg), 12 h (3.88 vs 10.2 mg), 24 h (6.96 vs 14.75 mg) <0.01 |
| Hanson et al []22 | 120 | All | TAP (59) vs IV Lidocaine (61) | 24 hr morphine consumption | RCT (open label) | Bupivacaine 0.25% 30 mL + epi (US-guided unilateral TAP) | 24 h cumulative morphine use: TAP (14.6±3.2 mg) vs Lido group (15.9±2.4 mg); <0.001; 24-hour cumulative consumption for the TAP 18 mg (IQR: 7–30.5) and for the Lido group was 15 mg (IQR: 8.5–28) pain scores no diff; non-inferior |
| Sharipova et al []14 | 28 | LDKT | ESP (14) vs Control (14) | Morphine reduction | Retrospective case-control | ESP block (T10–T11, bupivacaine 0.25% 20 mL initial +0.125% 20 mL q6h ×24 h) | ↓ NRS (2.1±1.1 vs 3.3±1.2 rest); ↓ morphine (4.7±6.2 vs 15.9±7.1 mg); ↓ PONV |
| Theeraratvarasin et al []23 | 46 | All | QL (23) vs LWI (23) | NRS + morphine consumption | RCT (double-blind) | Bupivacaine 0.25% 20 mL (US-guided inside-out QL3 vs LWI) | ↓ NRS at 2 h (5 [IQR 4–7] vs 7 [IQR 7–8]) and 4 h (3 vs 6); ↓ cumulative morphine (5 [IQR 3–8] vs 8 [IQR 5–13]) |
| Sindwani et al []24 | 60 | All | QLB (30) vs Placebo (30) | Opioid consumption | RCT (double-blind) | 0.25% bupivacaine 20 mL (single injection QLB type 1) | NRS significantly lower at 1, 4, 8, 12, 24 h (<0.001); ↓ fentanyl use (242±95 μg vs 769±90 μg); no PONV or motor weakness reported |
| Ojha et al []25 | 62 | LDKT | Continuous TAP (31) vs Epidural (31) | Opioid consumption | RCT (open label) | TAP: posterior approach US-guided 20 mL 0.25% ropivacaine + continuous infusion (24 h); Epidural: 0.25% ropivacaine 4–10 mL/h | NRS at rest and on coughing similar between groups (all >0.05); 24 h fentanyl uses 685±77 μg (TAP) vs 695±78 μg (Epidural); non-inferior analgesia; no complications |
| Chae et al []3 | 524 | LDKT | TAP(262) vs LWI (262) | Opioid consumption and pain scores | Retrospective PS-matched analysis | 0.375% ropivacaine 20 mL (US-guided single-shot TAP vs LWI by surgeon) | VAS ↓ at 1 h (3.5±1.1 vs 4.7±1.4), 4 h (3.6±1.0 vs 4.7±1.4), 8 h (3.0±0.9 vs 3.8±1.5), <0.001; ↓ opioid use (fentanyl 68±31 μg vs 119±72 μg; IV-PCA 55.9±10.2 vs 69.7±18.2 mL); no toxicity or PONV difference |
| This table presents the key characteristics and outcomes of studies included in the meta-analysis, detailing study design, patient population, type of nerve block, anesthetic regimen, timing of intervention, and postoperative analgesic outcomes. Reported variables include opioid consumption, pain scores, complications, and other clinically relevant endpoints. “↓”denotes a decrease, “−” denotes an increase. DDKT – deceased-donor kidney transplantation; LDKT – living-donor kidney transplantation; RCT – randomized controlled trial; PSM – propensity score-matched; TAP – transversus abdominis plane; QL – quadratus lumborum; ESP – erector spinae plane; II–IH – ilioinguinal–iliohypogastric; LA – local anesthetic; PCA – patient-controlled analgesia; VAS – visual analog scale; NRS – numeric rating scale; POD – postoperative day; NS – not significant; NA – not available; US – ultrasound; PACU – post-anesthesia care unit; LWI – local wound infiltration; Lido – lidocaine; epi – epinephrine; IQR – interquartile range; q6h – every 6 hours; mg – milligram; μg – microgram; mL – milliliter. | |||||||