Evidence for regional block-based analgesia in robot-assisted transaxillary thyroidectomy: a systematic review and meta-analysis
In brief
Regional nerve blocks lower early pain by ~1.3 points after robot thyroidectomy
In a meta-analysis of 224 patients, peri-operative nerve blocks reduced visual analog scale pain scores by about 1.4 points at 4 hours and 1.3 points at 24 hours, with a smaller 0.5-point benefit at 48 hours, while adding roughly 3 minutes to operative time. The findings suggest improved analgesia for the transaxillary approach, but larger trials are needed to confirm clinical relevance.
- Journal
- Journal of robotic surgery (Q1)
- Published
- 24 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ling Liu, Long-Hao Liu, Hong-Ying Liu, Gui-Yuan Chen, Jun Feng, Yang Liu
- PMID
- 42635868
- DOI
- 10.1007/s11701-026-03849-w
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 30 August 2026): Systematic review, regional block improves analgesia
- Picked for Anatomy (top studies of the week, 30 August 2026): Regional block analgesia in robot-assisted thyroidectomy
- Picked for Anesthesiology and Pain Medicine (paper of the day, 26 August 2026): Regional block improves analgesia after robot thyroidectomy
Abstract
To evaluate the analgesic effectiveness of perioperative regional nerve blocks after robot-assisted transaxillary thyroidectomy. A comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science was performed from database inception through December 31, 2025. Methodological quality was evaluated with the revised Cochrane risk-of-bias tool (RoB 2) for randomized controlled trials and the Newcastle-Ottawa Scale for the retrospective cohort study. Statistical synthesis was performed in Stata version 18.0. Continuous outcomes were pooled as weighted mean differences (WMDs), whereas dichotomous outcomes were expressed as odds ratios (ORs), with both effect measures reported alongside their corresponding 95% confidence intervals. The final analysis included four studies-three randomized controlled trials and one retrospective cohort study-encompassing 224 patients, of whom 113 received a regional nerve block and 111 served as controls; all evaluated robot-assisted thyroidectomy performed via a transaxillary approach. Perioperative nerve blocks were associated with lower visual analog scale (VAS) pain scores at 4 h (WMD = - 1.44, 95% CI: -2.43, - 0.45; P = 0.005), 24 h (WMD = - 1.28, 95% CI: -1.74, - 0.82; P < 0.001), and 48 h (WMD = - 0.47, 95% CI: -0.79, - 0.14; P = 0.005), as well as lower post-anesthesia care unit (PACU) pain scores (WMD = - 2.68, 95% CI: -3.31, - 2.06; P < 0.001). Nerve blocks were associated with a modest increase in operative time (WMD = 2.67, 95% CI: 0.04, 5.30; P = 0.047). Current evidence suggests that perioperative regional nerve blocks may improve postoperative analgesia after robot-assisted transaxillary thyroidectomy, with larger reductions in pain scores during the first 24 h and a smaller between-group difference at 48 h. However, larger randomized trials are needed to confirm these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.