{
  "abstract": "Background Regional analgesia (RA) is increasingly used in pediatric cardiac surgery, but evidence supporting its benefit remains fragmented. This systematic review and meta-analysis aimed to determine the “class effect” of RA.Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Data sources included PubMed, Embase, Cochrane Library, and Web of Science, searched up to July 10, 2025. We included RCTs of pediatric patients undergoing cardiac surgery that compared any RA technique (neuraxial, peripheral nerve blocks, or local infiltration) against general anesthesia with systemic analgesia alone.Results 31 RCTs (n=2245) were included. Adjunctive RA was associated with significant reductions in intraoperative fentanyl (MD −2.50 µg·kg⁻¹; 95% CI −3.84 to −1.15; 95% PI −9.51 to 4.52; I²=97%), 24-hour intravenous morphine (MD −0.33 mg·kg⁻¹; 95% CI −0.55 to −0.11; 95% PI −1.17 to 0.51; I²=96%), and improved recovery. Benefits included shorter time to tracheal extubation (MD −1.72 hours; 95% CI −2.93 to −0.52; 95% PI −7.78 to 4.34; I²=99%), reduced ICU stay (MD −0.25 days; 95% CI −0.34 to −0.16; 95% PI −0.61 to 0.11; I²=93%), and prolonged time to first analgesia (MD 2.95 hours; 95% CI 1.86 to 4.04; 95% PI -1.42 to 7.31; I²=97%). Subgroup analyses showed outcome-specific, inconsistent effects.Conclusion There is very low to low certainty of evidence that adjunctive RA is associated with reduced opioid exposure and improved recovery in pediatric cardiac surgery. Substantial heterogeneity and imprecision markedly reduce confidence in the estimated effects, which should therefore be interpreted cautiously.Registration PROSPERO CRD420251073543.",
  "authors": [
    {
      "affiliations": [
        "Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"
      ],
      "name": "Bruno Francisco Minetto Wegner"
    },
    {
      "affiliations": [
        "Universidade Federal da Fronteira Sul Campus Passo Fundo Curso de Graduacao em Medicina, Passo Fundo, Brazil"
      ],
      "name": "Gustavo Roberto Minetto Wegner"
    },
    {
      "affiliations": [
        "Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil"
      ],
      "name": "Gabriel Lemos González"
    },
    {
      "affiliations": [
        "Instituto Nacional de Cancer, Rio de Janeiro, Brazil"
      ],
      "name": "Vitor Alves Felippe"
    },
    {
      "affiliations": [
        "Universidade Federal de São Paulo, São Paulo, Brazil"
      ],
      "name": "Alesson Marinho"
    },
    {
      "affiliations": [
        "University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Tatiana Souza Nascimento"
    },
    {
      "affiliations": [
        "University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Archit Sharma"
    }
  ],
  "title": "Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials",
  "uid": "2731703a-e184-5ed8-b5dd-3382a81d8e37"
}