Saudi Journal of Anaesthesia最新文献

{"title":"Analgesic efficacy and safety of transversus abdominis plane block in women undergoing cesarean delivery: An umbrella review of systematic reviews and meta-analyses.","authors":"Abhijit Sukumaran Nair, Tuhin Mistry, Nitinkumar Borkar","doi":"10.4103/sja.sja_998_25","DOIUrl":"10.4103/sja.sja_998_25","url":null,"abstract":"<p><p>Intrathecal morphine (ITM) remains the benchmark for post-cesarean analgesia but is frequently associated with opioid-related adverse effects. Regional analgesia techniques such as transversus abdominis plane block (TAPB) are increasingly used as an opioid-sparing alternative. Multiple systematic reviews and meta-analyses (SRMAs) have evaluated TAPB efficacy, yet findings remain fragmented, heterogeneous, and methodologically inconsistent. This umbrella review synthesizes and critically appraises the highest-level evidence on the analgesic efficacy and safety of TAPB after cesarean delivery (CD). A PROSPERO-registered umbrella review was conducted according to PRISMA 2020 and PRIOR guidelines. SRMAs of randomized controlled trials (RCTs) evaluating TAPB for post-cesarean analgesia were systematically searched across major databases until October 31, 2025. Methodological quality was assessed using AMSTAR-2, overlap quantified via corrected covered area (CCA), and pooled findings reanalyzed using the metaUmbrella platform. Evidence credibility was evaluated using Ioannidis' criteria and certainty using GRADE. Fourteen SRMAs encompassing 125 RCTs (60 unique) were included. Study overlap was moderate (CCA 8.33%). AMSTAR-2 ratings revealed variable quality: four high-quality, eight low-quality, and two critically low-quality reviews. Reanalysis demonstrated that TAPB provided small but statistically significant reductions in 24-hour pain at rest (SMD - 0.11), pain on movement (SMD - 0.12), and opioid consumption (SMD - 0.19). All achieved Class IV (weak) evidence with low GRADE certainty. No significant differences were observed in early (6-12-hour) pain or time-to-rescue analgesia. TAPB showed a favorable trend toward reduced postoperative nausea and vomiting, though with high heterogeneity. ITM offered modestly superior early analgesia, but differences were below minimal clinically important thresholds and accompanied by more opioid-related side effects. Despite extensive literature, the overall credibility and certainty of evidence supporting TAPB after CD remain weak due to heterogeneity, methodological limitations, and review redundancy. TAPB provides modest analgesic benefit and improved tolerability, supporting its role when neuraxial opioids are omitted, contraindicated, or declined. High-quality RCTs, standardized TAPB techniques, and core outcome sets are needed to refine clinical recommendations.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"655-664"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic nerve sheath diameter as a prognostic tool for postdural puncture headache in pregnant women undergoing caesarean section under spinal anesthesia: A cross-sectional study.","authors":"N Amulya, Lavanya Kaparti, Suresh N Kumar","doi":"10.4103/sja.sja_52_26","DOIUrl":"10.4103/sja.sja_52_26","url":null,"abstract":"<p><strong>Context: </strong>Postdural puncture headache (PDPH) is a common and debilitating complication following spinal anesthesia in obstetric patients, with few objective tools available for early prediction. Optic nerve sheath diameter (ONSD) measured by ultrasonography is a noninvasive surrogate marker of intracranial pressure changes and may aid in early risk stratification.</p><p><strong>Aim: </strong>To evaluate the prognostic utility of ONSD measurements in predicting PDPH among pregnant women undergoing cesarean section under spinal anesthesia.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 88 pregnant women aged between 18 and 40 years undergoing cesarean section under spinal anesthesia. ONSD was measured using ultrasonography with a 13-6 MHz probe at baseline (T0) and at 4 (T4), 24 (T24), 48 (T48), and 72 h (T72) postprocedure. PDPH was diagnosed using International Classification of Headache Disorders criteria.</p><p><strong>Statistical analysis used: </strong>Data were analyzed using SPSS version 22. Continuous variables were expressed as mean ± SD and categorical variables as frequencies and percentages. Student's <i>t</i>-test and Chi-square/Fischer's exact test were used as appropriate. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC curve analysis with calculation of area under the curve (AUC).</p><p><strong>Results: </strong>PDPH occurred in 12 patients (13.6%). Baseline ONSD values were comparable between groups. Patients who developed PDPH showed significantly lower ONSD values from T4 onward (<i>P</i> < 0.05). The best diagnostic performance was at T72 (AUC 0.776; 95% CI 0.663-0.889) with a cutoff ≤4.52 mm, yielding 91.7% sensitivity, 69.7% specificity, and 98.1% negative predictive value. ONSD reduction from baseline at T72 was significantly greater in the PDPH group (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>ONSD measurement at 72 h postspinal anesthesia is a sensitive and clinically useful prognostic tool for predicting PDPH in obstetric patients and may be incorporated into routine postoperative monitoring.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"533-537"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between dexamethasone and dexmedetomidine combined with bupivacaine on pain relief after shoulder arthroscopy: A randomized clinical trial.","authors":"Ahmed I Abd El Sabour, Alaa M A Attia, Mohamed A Abdelsalam, Hassnaa M A Baset, Wesam N Ali","doi":"10.4103/sja.sja_920_25","DOIUrl":"10.4103/sja.sja_920_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management following shoulder arthroscopy remains a significant clinical challenge. Shoulder block modality, which combines axillary nerve block (ANB) with suprascapular nerve block (SSNB), provides analgesia with few reported hazards. Dexamethasone and dexmedetomidine are used as adjuvants to prolong analgesia, but their comparative efficacy remains unclear. This study evaluates their effectiveness with bupivacaine in SSNB and ANB for postoperative pain control.</p><p><strong>Patients and methods: </strong>This is a prospective, double-blind, randomized clinical study carried out at Assiut University Hospital. The study included 60 patients, between 20 to 65 years old, who were scheduled for elective shoulder arthroscopies under general anesthesia (ASA) class I or II. As an adjuvant to shoulder block in patients undergoing shoulder operations, patients were randomly divided into two equal groups: Dexamethasone group and Dexmedetomidine group. The Dexamethasone group received bupivacaine 0.5% (20 mL) with dexamethasone (4 mg in 1 mL), while the Dexmedetomidine group received bupivacaine 0.5% (20 mL) plus dexmedetomidine (1 mcg/kg in 1 mL). A 24-hour postoperative numerical rating pain scale (NRS) rating and opioid consumption were recorded for both groups.</p><p><strong>Results: </strong>At several time intervals up to 24 hours postoperatively, patients in the dexmedetomidine group showed lower NRS ratings than those in the dexamethasone group (<i>P</i> < 0.05). The dexmedetomidine group's time to first analgesic request was substantially longer (19.86 ± 1.36 hours) than the dexamethasone group's (16.57 ± 1.17 hours) (<i>P</i> < 0.001). Additionally, the dexmedetomidine group consumed fewer opioids overall.</p><p><strong>Conclusion: </strong>Dexmedetomidine as an adjuvant in shoulder block provides more postoperative analgesia and lower opioid consumption.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"625-631"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Your \"clinical trial\" from submission to decision.","authors":"Abdelazeem Eldawlatly","doi":"10.4103/sja.sja_284_26","DOIUrl":"10.4103/sja.sja_284_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"487-488"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of high-flow nasal cannula versus conventional oxygen delivery during procedural sedation for ovum pickup in assisted reproductive technology.","authors":"Vishal Mohan, Bhavna Hooda, Shalendra Singh, Deepak Dwivedi, Josemine Davis","doi":"10.4103/sja.sja_180_26","DOIUrl":"10.4103/sja.sja_180_26","url":null,"abstract":"<p><strong>Background: </strong>Procedural sedation during ovum pickup (OPU) is often associated with transient hypoxemia and airway interventions. High-flow nasal cannula (HFNC) therapy may improve oxygenation during sedated procedures, but evidence in assisted reproductive techniques remains limited. This study compares HFNC with conventional low-flow oxygen (CFO) in maintaining oxygenation during OPU.</p><p><strong>Materials and methods: </strong>In this randomized controlled trial, 220 women undergoing OPU under propofol sedation were allocated to either CFO (Group C; <i>n</i> = 110) or HFNC (Group H; <i>n</i> = 110). The outcomes assessed included desaturation events, hemodynamic parameters, depth of sedation, airway interventions, and adverse events.</p><p><strong>Results: </strong>Hemodynamic and respiratory parameters remained stable and comparable between groups throughout the procedure and recovery. Desaturation events were more frequent in Group C (<i>P</i> = 0.161), and the need for rescue escalation of oxygen therapy was significantly higher in this group compared with the group H (13.6% vs. 5.5%; <i>P</i> = 0.03). Total Propofol consumption, procedure duration, recovery time, and adverse events were similar, with high patient and physician satisfaction in both groups.</p><p><strong>Conclusion: </strong>HFNC provides a safe and effective alternative to CFO therapy during procedural sedation for OPU, significantly reducing the need for oxygen escalation without affecting hemodynamic stability, sedation depth, or recovery. Its routine use may enhance respiratory safety in sedated reproductive procedures.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"545-549"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total intravenous anesthesia with propofol and remifentanil followed by planned sedation with propofol alone in Intensive care for a patient with glutaric acidemia type-1 undergoing complex thoracolumbar scoliosis surgery.","authors":"Jonathan Mathers, Lars O Sandnes","doi":"10.4103/sja.sja_935_25","DOIUrl":"10.4103/sja.sja_935_25","url":null,"abstract":"<p><p>A 15-year-old boy with a severe phenotype of Glutaric Acidemia Type 1 (GA-1) presented for planned major thoracolumbar scoliosis correction under general anesthesia. Propofol is relatively contraindicated in patients with GA-1 according to latest guidance because of the risk of propofol infusion syndrome. Because of previous use of propofol in the patient when admitted to intensive care and the potential benefits as a sleep agent we decided to use propofol for his surgery and postoperative sedation. We report the successful use of propofol for general anesthesia and postoperative sedation on intensive care.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"695-697"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal phenol neurolysis for refractory perineal cancer pain: A case report.","authors":"Enrique Lacoba Díaz, Carles Espinós Ramírez, Guillem Urquijo Fernández, Jordi Pérez Martínez","doi":"10.4103/sja.sja_47_26","DOIUrl":"10.4103/sja.sja_47_26","url":null,"abstract":"<p><p>Intrathecal chemical neurolysis with phenol is a neuroablative technique reserved for cases of refractory cancer pain in which pharmacological strategies and less invasive interventional procedures have failed. We report the case of an 87-year-old man with stage IV prostate cancer and severe perineal pain refractory to strong opioids and adjuvant analgesics, who underwent intrathecal phenol neurolysis as a last-resort intervention. Within 24 hours, the patient experienced a marked improvement in pain control, allowing progressive tapering and eventual discontinuation of systemic opioids. Adequate analgesia was maintained until the patient's death during the same admission, in the context of disease progression, without recurrence of severe pain. This case illustrates the potential role of intrathecal phenol in carefully selected palliative-care scenarios, where the primary therapeutic objective is relief of suffering and improvement of quality of life in terminal stages of illness.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"713-715"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating ChatGPT's accuracy in predicting postoperative nausea and vomiting risk and antiemetic prophylaxis planning: A study on simulated patient profiles.","authors":"Hubba Ahmed, Tooba Usman, Alina Mahmood, Umama Masnoon, Maria Hashmi, Muhammad M Ali","doi":"10.4103/sja.sja_212_26","DOIUrl":"10.4103/sja.sja_212_26","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) is a distressing condition following general anesthesia. The Apfel Simplified Score (SRS) is used to calculate the score and guide antiemetic prophylaxis as per Society of Ambulatory Anesthesia (SAMBA) guidelines. The use of generative AI models in exploring the risk calculation and guiding antiemetic prophylaxis remains unexplored.</p><p><strong>Objective: </strong>The study aims to investigate the accuracy of ChatGPT 4.0 unpaid version in determining the Apfel score and its adherence to the SAMBA antiemetic prophylaxis guideline recommendations using simulated patient profiles.</p><p><strong>Methodology: </strong>Our study was conducted in the Department of Anesthesiology on 100 simulated patient profiles. The study was completed in 2 months after approval by the Institutional Review Board of Dow University of Health Sciences. Data were collected and analyzed using SPSS. A pilot study was conducted to determine the sample size for the study. The simulated profiles were generated by the researchers, and then ChatGPT was asked to calculate their Apfel scores. Experienced anesthesiologists were asked to calculate the same variables for the profiles, but they were blinded to ChatGPT's responses.</p><p><strong>Results: </strong>Among 100 simulated patient profiles, 99 profiles were scored correctly by ChatGPT and showed near-perfect agreement with anesthesiologists (Cohen's κ = 0.975, <i>P</i> < 0.001), with 98% concordance in risk stratification (κ = 0.953, <i>P</i> < 0.001). However, ChatGPT's adherence to SAMBA anti-emetic prophylaxis guidelines was low, showing only 31% correct recommendations in simulated profiles (κ = 0.141, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>ChatGPT can be reliably used to determine the correct Apfel score of the patients, and it can accurately classify patients into risk categories. However, its recommendations of antiemetic agents as per the SAMBA guidelines are inconsistent, necessitating human oversight for guideline-based management. Such large language models can be used as adjuncts in perioperative assessments and cannot replace human judgment.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"586-591"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence, predictors, and clinical impact of postoperative sleep disturbance: A prospective cohort study.","authors":"Alaa Mohamed, Mohamed Bashir, Yousef Salem Alqahtani, Feras Ayman Albunayyan, Mazen Atiah Alharbi, Dawood Shabanah","doi":"10.4103/sja.sja_921_25","DOIUrl":"10.4103/sja.sja_921_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sleep disturbance (POSD) is a pervasive and an overlooked complication; however, the relative importance of its modifiable drivers and their direct impact on clinically relevant outcomes remains inadequately quantified. This study aimed to determine the prevalence of POSD, identify its key modifiable predictors, and investigate its association with opioid consumption and hospital length of stay (LOS).</p><p><strong>Methods: </strong>A prospective observational cohort study was conducted at a tertiary care center. We enrolled 143 adult patients undergoing elective surgery under general anesthesia. Sleep quality was assessed on the first postoperative morning using a modified version of the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression identified predictors of sleep duration. Post-hoc analyses included a Pearson correlation between global PSQI score and 24-hour opioid consumption (Morphine Milligram Equivalents, MME), and a Mann-Whitney U test to compare LOS between good (PSQI ≤ 5) and poor sleepers (PSQI > 5).</p><p><strong>Results: </strong>The prevalence of poor sleep quality was 89.5% (128/143). Regression analysis revealed that sleep disturbance (β = 0.702, <i>P</i> < 0.001), sleep efficiency (β = 0.288, <i>P</i> < 0.001), and sleep latency (β = 0.224, <i>P</i> = 0.005) were significant predictors of sleep duration (R² = 0.348, <i>P</i> < 0.001). A significant positive correlation was found between global PSQI score and 24-hour MME (r = 0.41, <i>P</i> < 0.001). Patients with poor sleep had a longer median LOS of 4 days (IQR: 3-6) compared to 3 days (IQR: 2-4) in patients with good sleep (<i>P</i> = 0.018).</p><p><strong>Conclusion: </strong>POSD is highly prevalent and primarily driven by modifiable, environment-related factors. Its strong associations with increased opioid requirements and prolonged hospitalization underscore the critical need to implement nonpharmacological sleep promotion protocols as a standard component of postoperative care.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"500-507"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector spinae plane block versus transversus abdominis plane block on postoperative analgesia among patients undergoing hysterectomy: A systematic review and meta-analysis of randomized controlled trials.","authors":"Ahmed Goda Ahmed, Saeed Baradwan, Wael Mohamed Elmahdi Ibrahim, Othman Saadeldien Yahia, Doaa Mohamed Almonayery, Asmaa Ibraheim Tolba Gad, Amira Ibrahim Lashin, Mona Salah Eldin Sayed, Sherif Kamal Arafa, Ahmed Mohamed Abdelhakim, Amr Ahmed Magdy, Ahmed Abdelaziz Shama","doi":"10.4103/sja.sja_39_26","DOIUrl":"10.4103/sja.sja_39_26","url":null,"abstract":"<p><strong>Background: </strong>While the transversus abdominis plane block (TAPB) is commonly used for postoperative analgesia after abdominal procedures, the erector spinae plane block (ESPB) has recently gained attention as an alternative regional anesthesia technique with potential advantages in managing visceral pain. We aimed to conduct a systematic review and meta-analysis to assess the analgesic efficacy of ESPB compared to TAPB under ultrasound guidance following hysterectomy.</p><p><strong>Materials and methods: </strong>A comprehensive search was conducted across PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus to identify randomized controlled trials (RCTs) comparing ESPB versus TAPB for pain relief in patients undergoing hysterectomy through January 2026. Meta-analysis was conducted using RevMan software: Review Manager (RevMan), version 5.4.0, The Cochrane Collaboration, Copenhagen, Denmark. The primary outcome was postoperative pain intensity assessed by the 10-cm visual analog scale (VAS), with clinical significance evaluated using minimal clinically important difference (MCID) analysis (threshold 1.0 cm). Secondary outcomes included postoperative opioid consumption and incidence of nausea and vomiting.</p><p><strong>Results: </strong>Six RCTs involving 447 patients were included. ESPB demonstrated significantly lower VAS pain scores compared to TAPB at 2, 4, 6, 12, and 24 h postoperatively (<i>P</i> < 0.001). MCID analysis revealed that clinical benefit was most pronounced in the early postoperative period, particularly at 2 h. Patients receiving ESPB had significantly lower 24-h opioid consumption (<i>P</i> < 0.001) and reduced incidence of postoperative nausea and vomiting (PONV) (<i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>ESPB demonstrates superior analgesia compared to TAPB following hysterectomy, particularly in the early postoperative period, with reduced opioid consumption and PONV incidence. Further research with standardized protocols is warranted.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"491-499"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}