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- Title
Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis.
- Authors
Lohmöller, Katharina; Carstensen, Vivian; Pogatzki-Zahn, Esther M.; Freys, Stephan M.; Weibel, Stephanie; Schnabel, Alexander
- Abstract
Background: Postoperative pain management following laparoscopic, non-oncological visceral surgery in adults is challenging. Regional anaesthesia could be a promising component in multimodal pain management. Methods: We performed a systematic review and meta-analysis with GRADE assessment. Primary outcomes were postoperative acute pain intensity at rest/during movement after 24 h, the number of patients with block-related adverse events and the number of patients with postoperative paralytic ileus. Results: 82 trials were included. Peripheral regional anaesthesia combined with general anaesthesia versus general anaesthesia may result in a slight reduction of pain intensity at rest at 24 h (mean difference (MD) − 0.72 points; 95% confidence interval (CI) − 0.91 to − 0.54; I2 = 97%; low-certainty evidence), which was not clinically relevant. The evidence is very uncertain regarding the effect on pain intensity during activity at 24 h (MD -0.8 points; 95%CI − 1.17 to − 0.42; I2 = 99%; very low-certainty evidence) and on the incidence of block-related adverse events. In contrast, neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) may reduce postoperative pain intensity at rest in a clinical relevant matter (MD − 1.19 points; 95%CI − 1.99 to − 0.39; I2 = 97%; low-certainty evidence), but the effect is uncertain during activity (MD − 1.13 points; 95%CI − 2.31 to 0.06; I2 = 95%; very low-certainty evidence). There is uncertain evidence, that neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) increases the risk for block-related adverse events (relative risk (RR) 5.11; 95%CI 1.13 to 23.03; I2 = 0%; very low-certainty evidence). Conclusion: This meta-analysis confirms that regional anaesthesia might be an important part of multimodal postoperative analgesia in laparoscopic visceral surgery, e.g. in patients at risk for severe postoperative pain, and with large differences between surgical procedures and settings. Further research is required to evaluate the use of adjuvants and the additional benefit of regional anaesthesia in ERAS programmes. Protocol registration: PROSPERO CRD42021258281.
- Subjects
ABDOMINAL surgery; PAIN measurement; MEDICAL information storage &; retrieval systems; CONDUCTION anesthesia; PATIENT safety; GRAPHIC arts; DATA analysis; POSTOPERATIVE pain; LAPAROSCOPIC surgery; META-analysis; UNCERTAINTY; RELATIVE medical risk; TREATMENT effectiveness; DESCRIPTIVE statistics; SYSTEMATIC reviews; MEDLINE; RESEARCH bias; PAIN management; DRUG efficacy; COMBINED modality therapy; ACQUISITION of data; NARCOTICS; GENERAL anesthesia; CONFIDENCE intervals; ONLINE information services; HEALTH outcome assessment; DATA analysis software; TREATMENT effect heterogeneity; NERVE block; BOWEL obstructions; EVALUATION; ADULTS
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2024, Vol 38, Issue 4, p1844
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-023-10667-w