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.

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

“…The PECS 2 block reduced median (IQR [range]) morphine consumption in the first 24 h from 6 (3-9 [1-25]) mg after the serratus plane block to 4 (2-7 [0-37]) mg, p = 0.04. However, acute pain scores after serratus plane and PECS 2 blocks were similar, median (IQR [range]) 23 [0-70]) mm vs. 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) [0-61]) mm, respectively, p = 0.44.…”

“…Regional anaesthesia can reduce acute and chronic postoperative pain [9][10][11]. Thoracic epidural anaesthesia and thoracic paravertebral block have been associated with reduced chronic pain after mastectomy and thoracotomy [9][10][11][12][13][14]. In some rare cases, however, both techniques can cause complications, including hypotension, pneumothorax and haematoma [15][16][17].…”

Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial

“…In the current study, PVB decreased PTPS intensity more significantly than ketamine. Weinstein et al compared regional anesthesia with conventional treatment to study the incidence of persistent pain in a meta-analysis [32]. Interestingly, only a single study presented significant differences between epidural anesthesia and conventional treatment supporting regional anesthesia techniques [33].…”

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

“…Depending on the surgical procedure, peripheral nerve catheters can provide complete analgesia and negate the need for additional forms of pain relief during the recovery period. This may lead to improvements in patient satisfaction, and to reductions in opioid use, hospital length of stay and persistent postoperative pain . There may also be improvements in functional rehabilitation including earlier mobilisation, greater range of joint motion and better engagement with physiotherapy .…”