{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T17:30:09Z","timestamp":1779903009163,"version":"3.53.1"},"reference-count":63,"publisher":"BMJ","issue":"5","funder":[{"name":"Ontario Ministry of Health and Long-Term Care Clinician Investigator Program Salary Support Grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,4,20]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2024-105479","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T13:15:19Z","timestamp":1715001319000},"page":"441-448","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review"],"prefix":"10.1136","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8120-9073","authenticated-orcid":false,"given":"Glen","family":"Katsnelson","sequence":"first","affiliation":[{"name":"University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-3897","authenticated-orcid":false,"given":"Connor T A","family":"Brenna","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Pain Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Physiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5469-4966","authenticated-orcid":false,"given":"Laura","family":"Gir\u00f3n-Arango","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Pain Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen M","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Women's College Hospital Research Institute, Women's College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-8843","authenticated-orcid":false,"given":"Richard","family":"Brull","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Pain Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Women's College Hospital Research Institute, Women's College Hospital, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,5,6]]},"reference":[{"key":"2025101111164745000_50.5.441.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-81132-8"},{"key":"2025101111164745000_50.5.441.2","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1071\/SH17067","article-title":"Epidemiology of gender Dysphoria and Transgender identity","volume":"14","author":"Zucker","year":"2017","journal-title":"Sex Health"},{"key":"2025101111164745000_50.5.441.3","unstructured":"Statistics Canada\u2014 Canada is the first country to provide census data on transgender and non-binary people 2022, Available: https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/220427\/dq220427b-eng.htm"},{"key":"2025101111164745000_50.5.441.4","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","article-title":"Transgender people: health at the margins of society","volume":"388","author":"Winter","year":"2016","journal-title":"The Lancet"},{"key":"2025101111164745000_50.5.441.5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1089\/trgh.2018.0014","article-title":"What is gender Dysphoria? 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