This meta-analysis assesses the efficacy and safety of the transversus thoracis muscle plane (TTP) block versus traditional opioid-based analgesia in pediatric patients undergoing cardiac surgery via median sternotomy. Utilizing a systematic search of PubMed, EMBASE, and the Cochrane Library, we included one randomized controlled trial and two observational studies, comprising 180 patients, to evaluate the impact of TTP block on perioperative opioid consumption and hospital length of stay. Statistical analyses, conducted with Rstudio 4.2.3 using the Paule-Mandel estimator and assessed for heterogeneity and bias, showed that while the TTP block group exhibited a significant reduction in intraoperative opioid use (mean difference -0.35 mg/Kg), no significant differences were observed in postoperative opioid consumption within the first 24 hours or ICU length of stay. This suggests that while TTP block may decrease intraoperative opioid requirements, its analgesic effects may not extend significantly into the postoperative period.