Background and Aims Transition-related surgery (TRS) is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients may be complicated by higher rates of mood and substance use disorders. Regional anesthesia techniques reduce pain severity and opioid requirements, thereby improving postoperative recovery. However, little is known regarding the effectiveness of regional anesthesia techniques for transgender patients undergoing TRS.

Methods A literature search was performed using Medline, Embase, Cochrane, and CINAHL databases. Original studies describing regional anesthesia approaches for patients undergoing TRS were included. The primary outcomes were pain scores and opioid requirements on the first postoperative day (POD1). Due to the heterogeneity of interventions and outcomes, findings underwent qualitative synthesis without meta-analysis.

Results Of 1652 studies identified, eight met criteria for inclusion. Three studies described chest surgery, comprising 201 patients of whom 84% were transgender men undergoing mastectomy with pectoralis blocks or local instillation anesthesia devices. The remaining five studies described genital surgery, comprising 50 patients of whom 56% were transgender women undergoing vaginoplasty with lumbosacral erector spinae plane blocks or epidural anesthetics. Overall, the eight studies broadly ascribed benefits to nerve blocks. Few studies directly compared regional and non-regional anesthesia; however, these studies unanimously reported lower pain scores and opioid requirements on POD1 with nerve blocks compared to none. Furthermore, anesthetic complications were rare among included studies.

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Abstract EP236 Figure 1

PRISMA flow diagram of identification, screening, and inclusion of studies through Covidence

Conclusions Regional anesthesia for TRS is understudied, which may be attributable to pervasive marginalization of transgender individuals. However, the limited existing literature does support regional anesthesia techniques as an effective option for TRS.