Regional Anesthesia May Cut Risk for Post-Op Chronic Pain

TOPLINEPatients who received regional anesthesia had a reduced risk for chronic postsurgical pain up to 12 months, especially after undergoing breast, knee, and thoracic surgeries.METHODOLOGYResearchers conducted a systematic review and meta-analysis of randomized trials to assess whether regional anesthesia reduced the risk for the long-term use of opioids or the incidence of chronic postsurgical pain.They included 158 trials published between 2000 and 2025 involving 18,794 adults (mean age, 55 years) who underwent surgeries such as mastectomy, thoracotomy, and joint replacement.Primary outcomes were the incidence of chronic postsurgical pain and long-term use of opioids, defined as at least 3 months after surgery, with follow-up up to 2 years.Researchers compared neuraxial or peripheral regional techniques with no block, a placebo, or other regional blocks.Heterogeneity (I2) and the certainty of evidence were assessed. The risk for bias was graded as high in 51% of trials, low in 30%, and unclear in 19%.TAKEAWAYRegional anesthesia was linked to a 27% reduced risk for chronic postsurgical pain compared with no regional anesthesia (risk ratio [RR], 0.73; 95% CI, 0.67-0.80; 79 trials; I2, 59.1%), with low certainty of evidence. The effect persisted up to 12 months but not at 24 months.On pooling trials by procedure, regional anesthesia was linked to a significantly reduced risk for chronic pain after mastectomy, thoracotomy, video-assisted thoracoscopic surgery, and knee arthroplasty, with I2 up to 66.3%.The meta-analysis found that neuraxial blocks were linked to a lower risk for chronic pain than peripheral blocks after thoracotomy (RR, 0.64 vs 0.84; I2, 19.6%) and video-assisted thoracoscopic surgery (RR, 0.60 vs 0.77; I2, 30%).Regional anesthesia did not significantly reduce the long-term use of opioids (seven trials).IN PRACTICE“Low-certainty evidence supports the use of regional anesthesia as an effective method for reducing the incidence of CPSP [chronic postsurgical pain] after surgery,” the researchers of the study reported.SOURCEThe study was led by Martin Taylor-Rowan, University of Glasgow, Glasgow, Scotland. It was published online on July 09 in the British Journal of Anaesthesia.LIMITATIONSTrials often excluded patients with high risk for chronic postsurgical pain at baseline. Most trials had small sample sizes. Heterogeneity in defining outcome and methods for pain assessment may have weakened the analysis.DISCLOSURESThe study received funding from the National Institute for Health and Care Research Evidence Synthesis Programme. The authors declared having 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.