Weinstein EJ et.al conducted a study to determine if the use of Regional/local anesthesia at the time of surgery reduces the risk of having pain that persists for three months and more after surgery. The comparison was with pain killers alone, such as opioids and non-steroidal anti-inflammatory drugs.
The study involved 63 randomized controlled trials (RCTs) with participants undergoing open chest, heart, breast, abdominal, vascular, gynaecological and other surgery, but not orthopaedic surgery. The types of surgery included surgery with a high event rate of persistent pain after surgery, such as breast surgery, limb amputation and opening the chest, and surgery with a lower risk but high numbers of procedures, such as caesarean section.
Results from 41 RCTs enrolling a total of 3143 participants were analyzed.Regional anaesthesia reduced the number of people who experienced persistent pain after undergoing non-orthopaedic surgery. For open chest surgery, giving an epidural halved the odds of a person having persistent postoperative pain at three to 18 months after surgery. Seven people needed to be treated in this way for one to benefit.
For the prevention of persistent pain three to 12 months after breast cancer surgery, seven people needed regional anaesthesia for one to benefit
Infusion of local anaesthetic into a vein was shown to reduce the risk of persistent pain three to six months after breast, with three people needing to be treated for one to benefit. Regional anaesthesia reduced the odds by more than half of a woman experiencing persistent pain after caesarean section . The number of women treated for one to benefit was 19.
The study concluded 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 anaesthesiamay 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.
The study found consistent evidence supporting the use of regional anaesthesia in adults to prevent persistent pain after a number of types of surgery. However, variations were observed in the effect sizes, and at different times after surgery.
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