Analgesic effects of transversus abdominis plane and quadratus lumborum blocks are not clinically meaningful for laparoscopic nephrectomy: systematic review and network meta-analysis.

Background: Ultrasound-guided abdominal wall blocks are increasingly used to enhance postoperative analgesia in laparoscopic nephrectomy. Among these, the transversus abdominis plane (TAP) block and the quadratus lumborum (QL) block have emerged as promising techniques. However, no comprehensive review has yet compared the analgesic efficacy of these two regional approaches. Methods: An extensive search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar to identify randomized controlled trials comparing the postoperative analgesic effects of the TAP block, QL block, and systemic analgesia. The primary outcome was 24-hour opioid consumption, standardized to intravenous morphine milligram equivalents (MME). Secondary outcomes included postoperative pain scores assessed using a 0-10 Visual Analog Scale (VAS). A minimal clinically important difference (MCID) was defined as a reduction of 10 mg MME or 1 point on the VAS. Results: Twelve studies were included. Both TAP and QL blocks significantly reduced opioid consumption compared to systemic analgesia (mean difference [95% confidence interval, CI]: QL, -11.42 mg [-18.88 to -3.97]; TAP, -10.88 mg [-17.49 to -4.26]). However, the 95% CI did not meet the predefined MCID of -10 mg. Similarly, improvements in postoperative pain scores did not reach clinical significance. Conclusions: While TAP and QL blocks demonstrated a significant analgesic effect compared to systemic analgesia, the clinical relevance of this benefit may be limited.