From the Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Anesth Analg. 2024 Oct 1;139(4):711-722. doi: 10.1213/ANE.0000000000006947. Epub 2024 Sep 4.
Whether regional anesthesia impacts the development of chronic postsurgical pain is currently debateable, and few studies have evaluated an effect on prolonged opioid use. We sought to systematically review the effect of regional anesthesia for adults undergoing noncardiac elective surgery on these outcomes.
A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and CINHAL for randomized controlled trials (from inception to April 2022) of adult patients undergoing elective noncardiac surgeries that evaluated any regional technique and included one of our primary outcomes: (1) prolonged opioid use after surgery (continued opioid use ≥2 months postsurgery) and (2) chronic postsurgical pain (pain ≥3 months postsurgery). We conducted a random-effects meta-analysis on the specified outcomes and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to rate the quality of evidence.
Thirty-seven studies were included in the review. Pooled estimates indicated that regional anesthesia had a significant effect on reducing prolonged opioid use (relative risk [RR] 0.48, 95% CI, 0.24-0.96, P = .04, I 2 0%, 5 trials, n = 348 patients, GRADE low quality). Pooled estimates for chronic pain also indicated a significant effect favoring regional anesthesia at 3 (RR, 0.74, 95% CI, 0.59-0.93, P = .01, I 2 77%, 15 trials, n = 1489 patients, GRADE moderate quality) and 6 months (RR, 0.72, 95% CI, 0.61-0.85, P < .001, I 2 54%, 19 trials, n = 3457 patients, GRADE moderate quality) after surgery. No effect was found in the pooled analysis at 12 months postsurgery (RR, 0.44, 95% CI, 0.16-1.17, P = .10).
The results of this study suggest that regional anesthesia potentially reduces chronic postsurgical pain up to 6 months after surgery. Our findings also suggest a potential decrease in the development of persistent opioid use.
区域麻醉是否会影响慢性术后疼痛的发展目前仍存在争议，且很少有研究评估其对延长阿片类药物使用的影响。我们旨在系统回顾成人非心脏择期手术中应用区域麻醉对这些结局的影响。
系统检索 MEDLINE、EMBASE、CENTRAL 和 CINHAL 中自成立至 2022 年 4 月的评估任何区域技术的成人择期非心脏手术的随机对照试验，这些研究纳入了我们的主要结局之一：（1）术后延长阿片类药物使用（术后持续使用阿片类药物≥2 个月）和（2）慢性术后疼痛（术后≥3 个月疼痛）。我们对特定结局进行了随机效应荟萃分析，并使用推荐分级的评估、制定与评价（GRADE）方法对证据质量进行评级。
共纳入 37 项研究。汇总估计表明，区域麻醉对减少延长阿片类药物使用有显著影响（相对风险 [RR] 0.48，95%CI，0.24-0.96，P =.04，I 2 0%，5 项试验，n = 348 例患者，GRADE 低质量）。慢性疼痛的汇总估计也表明，区域麻醉在术后 3 个月（RR，0.74，95%CI，0.59-0.93，P =.01，I 2 77%，15 项试验，n = 1489 例患者，GRADE 中质量）和 6 个月（RR，0.72，95%CI，0.61-0.85，P <.001，I 2 54%，19 项试验，n = 3457 例患者，GRADE 中质量）时的效果有显著差异。在术后 12 个月的汇总分析中未发现效果（RR，0.44，95%CI，0.16-1.17，P =.10）。
本研究结果表明，区域麻醉可能减少术后 6 个月内的慢性术后疼痛。我们的研究结果还表明，区域麻醉可能减少持续性阿片类药物使用的发展。
