Perioperative Regional Anesthesia: Less Pain, Fewer Pills

TOPLINE:

The use of regional anesthesia reduces acute postoperative pain associated with noncardiac surgery. It also decreases the incidence of prolonged opioid use and chronic postoperative pain at 3 and 6 months after surgery.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 37 randomized controlled trials involving 4948 adults (age, ≥ 18 years) undergoing elective noncardiac surgeries.
• Data were extracted from the MEDLINE, EMBASE, CENTRAL, and CINAHL databases from inception to April 2022.
• Patients included in the analysis received regional anesthesia or control (eg, a placebo or sham procedure) during the perioperative period.
• The primary outcomes were prolonged use of opioids (continued use of opioids at least 2 months after surgery) and chronic postsurgical pain (pain lasting at least 3 months after surgery).
• The secondary outcomes were postoperative analgesic consumption at 24, 48, and 72 hours; need for additional analgesia in the postanesthesia care unit; pain scores at rest at 0-4, 4-12, 24, 48, and 72 hours postoperatively; and all reported adverse events.

TAKEAWAY:

• Perioperative regional anesthesia significantly reduced persistent opioid use (relative risk [RR], 0.48; P = .04) in a meta-analysis of five trials.
• Regional anesthesia led to a significant reduction in the rates of chronic postsurgical pain at 3 months (RR, 0.74; P = .01) and 6 months (RR, 0.72; P < .001).
• Regional anesthesia also reduced the consumption of opioids at 24 hours (P < .001) and 48 hours (P = .01) after surgery.
• Regional anesthesia also improved acute postoperative pain scores at 0-4 hours (P < .001) and 4-12 hours (P < .001). Three studies showed an increase in hypotension with neuraxial regional anesthesia (P = .01).

IN PRACTICE:

“Our investigation into prolonged opioid use emphasizes the potential role of regional anesthesia to mitigate this important societal outcome and underlines the need for large randomized controlled trials as this remains a clinically significant issue,” the authors of the study wrote.

SOURCE:

This study was led by Connor G. Pepper, MD, of the Department of Anesthesia at McMaster University, in Hamilton, Ontario, Canada. It was published online on September 4, 2024, in Anesthesia & Analgesia.

LIMITATIONS: 

The study included a limited number of trials that evaluated prolonged use of opioids, which reduced the certainty of the estimates. Significant heterogeneity was noted in outcomes such as postoperative pain scores and the consumption of analgesics. The authors acknowledged that the definition of “prolonged opioid use” was different from the 2019 Joint Consensus Statement on Persistent Postoperative Opioid Use. 

DISCLOSURES:

The study did not receive any specific funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.