Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Abstract

We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.

Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial

“…This multicenter, prospective, randomized, double-blind, placebo-controlled study shows that paravertebral block with ropivacaine and systemic multimodal analgesia did not reduce the incidence of chronic pain 3 months after breast surgery (primary endpoint of the study) compared to paravertebral block with saline and systemic multimodal analgesia. These results are similar to some other studies 2,9,10 that did not demonstrate a long-term benefit with paravertebral block analgesia despite a short-term benefit 3,4 but do not agree with the results of other studies. 11,12 Two recent meta-analyses showed no statistically significant reduction in the risk of persistent postoperative pain 3 to 12 months after breast cancer surgery.…”

Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial

“…This multicenter, prospective, randomized, double-blind, placebo-controlled study shows that paravertebral block with ropivacaine and systemic multimodal analgesia did not reduce the incidence of chronic pain 3 months after breast surgery (primary endpoint of the study) compared to paravertebral block with saline and systemic multimodal analgesia. These results are similar to some other studies 2,9,10 that did not demonstrate a long-term benefit with paravertebral block analgesia despite a short-term benefit 3,4 but do not agree with the results of other studies. 11,12 Two recent meta-analyses showed no statistically significant reduction in the risk of persistent postoperative pain 3 to 12 months after breast cancer surgery.…”

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

“…Two other systematic reviews (Heesen et al., 2016; Hussain et al., 2018) looked at the effect of the paravertebral block on chronic pain and both found a reduction in chronic pain in the conventional meta‐analysis but with an unclear conclusion of the TSA, which is similar to our findings. A Cochrane review (Weinstein et al., 2018) on chronic pain also found that paravertebral blocks reduced chronic pain after breast surgery and graded the evidence similarly to us as low. Our analysis additionally suggests that the paravertebral block has a significant impact on the risk of PONV, a clinically relevant endpoint from the patient's perspective.…”

The Assessment of Nursing Staff Knowledge and Barriers Regarding Aseptic Techniques in Khartoum Teaching Hospital, Sudan

“…Regarding the resource limitations and staff training that affect the availability or quality of sterile equipment and supplies, this result was supported by a study whose results suggest that resource limitations affecting the availability or quality of sterile equipment and supplies are identified barriers to aseptic practices [ 22 ]. The majority of the study participants (84.3%) indicated that there are obstacles to the optimal application of aseptic techniques; this finding was supported by a study by Gaines et al, who found that there are perceived barriers to creating and maintaining a sterile field during surgical procedures [ 23 ].…”

Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial

“…This multicenter, prospective, randomized, double-blind, placebo-controlled study shows that paravertebral block with ropivacaine and systemic multimodal analgesia did not reduce the incidence of chronic pain 3 months after breast surgery (primary endpoint of the study) compared to paravertebral block with saline and systemic multimodal analgesia. These results are similar to some other studies 2,9,10 that did not demonstrate a long-term benefit with paravertebral block analgesia despite a short-term benefit 3,4 but do not agree with the results of other studies. 11,12 Two recent meta-analyses showed no statistically significant reduction in the risk of persistent postoperative pain 3 to 12 months after breast cancer surgery.…”

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

“…Two other systematic reviews (Heesen et al., 2016; Hussain et al., 2018) looked at the effect of the paravertebral block on chronic pain and both found a reduction in chronic pain in the conventional meta‐analysis but with an unclear conclusion of the TSA, which is similar to our findings. A Cochrane review (Weinstein et al., 2018) on chronic pain also found that paravertebral blocks reduced chronic pain after breast surgery and graded the evidence similarly to us as low. Our analysis additionally suggests that the paravertebral block has a significant impact on the risk of PONV, a clinically relevant endpoint from the patient's perspective.…”

The Assessment of Nursing Staff Knowledge and Barriers Regarding Aseptic Techniques in Khartoum Teaching Hospital, Sudan

“…Regarding the resource limitations and staff training that affect the availability or quality of sterile equipment and supplies, this result was supported by a study whose results suggest that resource limitations affecting the availability or quality of sterile equipment and supplies are identified barriers to aseptic practices [ 22 ]. The majority of the study participants (84.3%) indicated that there are obstacles to the optimal application of aseptic techniques; this finding was supported by a study by Gaines et al, who found that there are perceived barriers to creating and maintaining a sterile field during surgical procedures [ 23 ].…”

Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial

“…This multicenter, prospective, randomized, double-blind, placebo-controlled study shows that paravertebral block with ropivacaine and systemic multimodal analgesia did not reduce the incidence of chronic pain 3 months after breast surgery (primary endpoint of the study) compared to paravertebral block with saline and systemic multimodal analgesia. These results are similar to some other studies 2,9,10 that did not demonstrate a long-term benefit with paravertebral block analgesia despite a short-term benefit 3,4 but do not agree with the results of other studies. 11,12 Two recent meta-analyses showed no statistically significant reduction in the risk of persistent postoperative pain 3 to 12 months after breast cancer surgery.…”

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

“…Two other systematic reviews (Heesen et al., 2016; Hussain et al., 2018) looked at the effect of the paravertebral block on chronic pain and both found a reduction in chronic pain in the conventional meta‐analysis but with an unclear conclusion of the TSA, which is similar to our findings. A Cochrane review (Weinstein et al., 2018) on chronic pain also found that paravertebral blocks reduced chronic pain after breast surgery and graded the evidence similarly to us as low. Our analysis additionally suggests that the paravertebral block has a significant impact on the risk of PONV, a clinically relevant endpoint from the patient's perspective.…”

The Assessment of Nursing Staff Knowledge and Barriers Regarding Aseptic Techniques in Khartoum Teaching Hospital, Sudan

“…Regarding the resource limitations and staff training that affect the availability or quality of sterile equipment and supplies, this result was supported by a study whose results suggest that resource limitations affecting the availability or quality of sterile equipment and supplies are identified barriers to aseptic practices [ 22 ]. The majority of the study participants (84.3%) indicated that there are obstacles to the optimal application of aseptic techniques; this finding was supported by a study by Gaines et al, who found that there are perceived barriers to creating and maintaining a sterile field during surgical procedures [ 23 ].…”