Network meta-analysis compares analgesic techniques for upper GI surgery pain

BACKGROUND: Optimal perioperative analgesia for upper gastrointestinal (UGI) surgery remains uncertain despite multiple available options. This network meta-analysis (NMA) evaluated the comparative effectiveness of local and regional analgesic techniques on postoperative pain and opiate consumption following open UGI surgery. METHODS: A Bayesian NMA of randomised controlled trials (RCTs) was performed using MEDLINE, Embase, PubMed, and CENTRAL (January 2010-November 2023). The primary outcome was postoperative pain intensity at rest at 24 h. RESULTS: Fifty-three RCTs (n = 4207 patients) were included. Epidural analgesia provided the greatest reduction in 24-h pain (Mean Difference (MD) -0.976; Credible Interval (CrI) -0.558,-1.401) and opiate consumption (MD -24.717; CrI -16.541,-33.355). The transversus abdominis plane (TAP) block significantly reduced pain at 24 and 48 h, while local wound infiltration and continuous wound catheter infusion demonstrated strong opioid-sparing effects. Only the TAP block resulted in a significant reduction in hospital length of stay. Sensitivity and procedure-specific analyses showed results consistent with the primary analysis. CONCLUSION: Epidural analgesia provides the greatest early analgesic and opioid-sparing benefit following open UGI surgery, though these effects do not consistently translate into improved recovery outcomes. TAP block and wound-based analgesic techniques offer effective, less invasive alternatives that may be preferable in selected patients.