{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T12:32:04Z","timestamp":1772886724071,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T00:00:00Z","timestamp":1725840000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National High\u2010Level Hospital Clinical Research Funding","award":["2022-GSP-GG-36"],"award-info":[{"award-number":["2022-GSP-GG-36"]}]},{"name":"National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences","award":["NCRC2020014"],"award-info":[{"award-number":["NCRC2020014"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,27]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Congenital heart disease is a common birth defect, but advancements in diagnosis and treatment have improved survival rates. Enhanced recovery after surgery (ERAS) programmes have emerged in paediatric cardiac surgery. Multimodal pain management, as a vital part of ERAS programmes, has been found to be effective in reducing pain and improving outcomes in cardiac surgery patients. Traditional methods of pain control using high-dose opioids can lead to complications, so nonopioid analgesics and regional anaesthesia techniques are being used to reduce the consumption. However, there is a significant variability in pain management practices in paediatric cardiac surgery. A network meta-analysis (NMA) is needed to comprehensively compare the effects of different analgesic interventions in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A comprehensive electronic literature database search will be performed using electronic databases, mainly including PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials. All randomised controlled trials associated with perioperative pain management for paediatric cardiac surgery will be included. The primary outcome will be visual analogue score or numeric rating scale of pain and total opioid consumption (or equivalent) 24\u2009hours after postoperative tracheal extubation. The Revised Cochrane Risk of Bias Tool will be employed to assess the quality of included articles. A random-effects pairwise meta-analysis will be performed to report the head-to-head comparison. Following the assessment of individual articles, an NMA will be conducted using a Bayesian framework with random-effects\u2019 models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not necessary because this study will be based on publications. The results of this study will be published in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023477520.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-084547","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T01:52:43Z","timestamp":1726019563000},"page":"e084547","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of perioperative pain management in paediatric cardiac surgery: a protocol for a network meta-analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0582-7739","authenticated-orcid":false,"given":"Haoqi","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengxue","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujun","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongbai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7928-3917","authenticated-orcid":false,"given":"Yuan","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3924-7548","authenticated-orcid":false,"given":"Su","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"2025121510423625000_14.9.e084547.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.07.030"},{"key":"2025121510423625000_14.9.e084547.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.012033"},{"key":"2025121510423625000_14.9.e084547.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2025121510423625000_14.9.e084547.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.060834"},{"key":"2025121510423625000_14.9.e084547.5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.14797\/mdcj-12-1-4","article-title":"Minimally Invasive Cardiovascular Surgery: incisions and Approaches","volume":"12","author":"Langer","year":"2016","journal-title":"Methodist Debakey Cardiovasc J"},{"key":"2025121510423625000_14.9.e084547.6","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.jtcvs.2021.04.072","article-title":"The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery","volume":"162","author":"Fuller","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121510423625000_14.9.e084547.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2010.04.003"},{"key":"2025121510423625000_14.9.e084547.8","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.jtcvs.2019.10.049","article-title":"Initial experience introducing an enhanced recovery program in congenital cardiac surgery","volume":"160","author":"Roy","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121510423625000_14.9.e084547.9","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1093\/ejcts\/ezy100","article-title":"Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial","volume":"54","author":"Li","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025121510423625000_14.9.e084547.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198711193172105"},{"key":"2025121510423625000_14.9.e084547.11","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/2150135118755977","article-title":"Pediatric Cardiac Surgery and Pain Management: after 40 Years in the Desert, Have We Reached the Promised Land?","volume":"9","author":"Pollak","year":"2018","journal-title":"World J Pediatr Congenit Heart Surg"},{"key":"2025121510423625000_14.9.e084547.12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1046\/j.1460-9592.1998.00239.x","article-title":"Modifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia","volume":"8","author":"Wolf","year":"1998","journal-title":"Pediatr Anesth"},{"key":"2025121510423625000_14.9.e084547.13","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/ACO.0000000000001262","article-title":"Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery","volume":"36","author":"Yamamoto","year":"2023","journal-title":"Curr Opin Anaesthesiol"},{"key":"2025121510423625000_14.9.e084547.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196912182812503"},{"key":"2025121510423625000_14.9.e084547.15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1213\/ANE.0000000000003831","article-title":"Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: a Systematic Review and Meta-analysis of Randomized Clinical Trials","volume":"128","author":"Monahan","year":"2019","journal-title":"Anesth Analg"},{"key":"2025121510423625000_14.9.e084547.16","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1213\/ANE.0000000000000446","article-title":"Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database","volume":"120","author":"Suresh","year":"2015","journal-title":"Anesth Analg"},{"key":"2025121510423625000_14.9.e084547.17","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1053\/j.semtcvs.2020.12.001","article-title":"A Minimal Opioid Postoperative Management Protocol in Congenital Cardiac Surgery: safe and Effective","volume":"34","author":"Frankel","year":"2022","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2025121510423625000_14.9.e084547.18","article-title":"The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children","volume":"2","author":"Guay","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121510423625000_14.9.e084547.19","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200005000-00002"},{"key":"2025121510423625000_14.9.e084547.20","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1053\/j.jvca.2019.02.003","article-title":"Toward Opioid-Free Fast Track for Pediatric Congenital Cardiac Surgery","volume":"33","author":"Esfahanian","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025121510423625000_14.9.e084547.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2025121510423625000_14.9.e084547.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025121510423625000_14.9.e084547.23","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2019013","article-title":"Network meta-analysis: application and practice using R software","volume":"41","author":"Shim","year":"2019","journal-title":"Epidemiol Health"},{"key":"2025121510423625000_14.9.e084547.24","doi-asserted-by":"crossref","first-page":"107303","DOI":"10.1016\/j.cmpb.2022.107303","article-title":"Using the bayesmeta R package for Bayesian random-effects meta-regression","volume":"229","author":"R\u00f6ver","year":"2023","journal-title":"Comput Methods Programs Biomed"},{"key":"2025121510423625000_14.9.e084547.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.016"},{"key":"2025121510423625000_14.9.e084547.26","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-2-201307160-00008"},{"key":"2025121510423625000_14.9.e084547.27","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3767"},{"key":"2025121510423625000_14.9.e084547.28","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2017047","article-title":"Network meta-analysis: application and practice using Stata","volume":"39","author":"Shim","year":"2017","journal-title":"Epidemiol Health"},{"key":"2025121510423625000_14.9.e084547.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2025121510423625000_14.9.e084547.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.10.164"},{"key":"2025121510423625000_14.9.e084547.31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/15533506211068930","article-title":"Evaluation of Different Pain-Control Procedures for Post-cardiac Surgery: a Systematic Review and Network Meta-Analysis","volume":"29","author":"Hu","year":"2022","journal-title":"Surg Innov"},{"key":"2025121510423625000_14.9.e084547.32","doi-asserted-by":"crossref","first-page":"4626","DOI":"10.1111\/jocn.16482","article-title":"Efficacy of non-pharmacological interventions in pain relief and opioid consumption after cardiac surgery: a systematic review and Bayesian network meta-analysis","volume":"32","author":"Liu","year":"2023","journal-title":"J Clin Nurs"},{"key":"2025121510423625000_14.9.e084547.33","doi-asserted-by":"crossref","first-page":"1078756","DOI":"10.3389\/fcvm.2023.1078756","article-title":"Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis","volume":"10","author":"Zhou","year":"2023","journal-title":"Front Cardiovasc Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-084547","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:42:46Z","timestamp":1765824166000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-084547"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,10]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/bmjopen-2024-084547"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-084547","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}