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Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review
  1. Glen Katsnelson1,
  2. Connor T A Brenna2,3,
  3. Laura Girón-Arango2,4,
  4. Yasmeen M Abdallah5 and
  5. Richard Brull2,5,6
  1. 1 University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  2. 2 Department of Anesthesiology & Pain Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  3. 3 Department of Physiology, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
  5. 5 Women's College Hospital Research Institute, Women's College Hospital, Toronto, Ontario, Canada
  6. 6 Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Richard Brull, Anesthesiology & Pain Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; richard.brull{at}uhn.ca

Abstract

Introduction Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery.

Methods We performed a systematic review of the literature to evaluate original reports characterizing the analgesic effectiveness of regional anesthetic techniques for patients undergoing chest and/or genital transition-related surgery. Our primary outcomes were pain severity and opioid requirements on the first postoperative day.

Results Of the 1863 records identified, 10 met criteria for inclusion and narrative synthesis. These included two randomized controlled trials, three cohort studies, and five case reports/series, comprising 293 patients. Four reports described 243 patients undergoing chest surgery, of whom 86% were transgender men undergoing mastectomy with pectoralis nerve blocks or local anesthetic instillation devices. The remaining six reports comprised 50 patients undergoing genital surgery, of whom 56% were transgender women undergoing vaginoplasty with erector spinae plane blocks or epidural anesthesia. Three studies directly compared regional techniques to parenteral analgesia alone. Two of these studies reported lower pain scores and opioid requirements on the first postoperative day with nerve blocks compared with none while the third study reported no difference between groups. Complications related to regional anesthetic techniques were rare among patients undergoing transition-related surgery.

Discussion Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.

  • REGIONAL ANESTHESIA
  • Pain, Postoperative
  • Nerve Block

https://doi.org/10.1136/rapm-2024-105479

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    Footnotes

    • X @KatsnelsonGlen, @CTA_Brenna, @lgiron86

    • Presented at An earlier derivative of this work was published in RAPM as an abstract presented at the European Society of Regional Anaesthesia & Pain Therapy meeting in 2023 (doi: 10.1136/rapm-2023-ESRA.296)

    • Contributors GK created search strategy, reviewed literature, screened articles, extracted and analyzed data, prepared first draft and edited manuscript. CB screened articles, extracted and analyzed data, and edited manuscript. LG-A screened articles and edited manuscript. YMA screened articles, extracted and analyzed data. RB supervised project and edited manuscript.

    • Funding CB receives salary support from the Ontario Ministry of Health and Long-Term Care (MOHLTC) Clinician Investigator Program Salary Support Grant (CIP-MOH). No other authors receive financial support relevant to the present article.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.