- Design
- Systematic review and network meta-analysis of RCTs
- Population
- 18,794 patients in 158 trials, various surgeries
- Primary outcome
- Chronic postsurgical pain incidence
- Effect
- RR 0.73 (95% CI 0.67 to 0.80); opioid use RR 0.88 (0.61 to 1.28)
This network meta-analysis pooled 158 randomised trials (18,794 patients) comparing regional anaesthesia with no block for preventing chronic postsurgical pain — pain persisting beyond three months.
Regional anaesthesia reduced chronic postsurgical pain (RR 0.73, 95% CI 0.67 to 0.80), with effects up to 12 months. Benefit was seen after mastectomy (RR 0.69), thoracotomy (0.72), VATS (0.73) and knee arthroplasty (0.71). After thoracic surgery, neuraxial techniques outperformed peripheral ones (thoracotomy 0.64 vs 0.84; VATS 0.60 vs 0.77). Surgery type, sex and baseline risk did not modify the effect. Long-term opioid use did not differ (RR 0.88, 0.61 to 1.28).
Certainty was low, reflecting trial quality and variation in definitions. But the consistency across operations makes a practical case: where chronic pain is common — breast, thoracic and knee surgery — a regional technique should be part of the plan unless there is a reason not to.
- Offer a regional technique for mastectomy, thoracic surgery and knee arthroplasty where no contraindication exists
- After thoracotomy or VATS, prefer a neuraxial technique such as thoracic epidural where feasible
- Discuss chronic pain risk at consent; about one in four cases may be prevented
- Do not expect blocks alone to reduce long-term opioid use
- Screen at follow-up for pain persisting beyond three months
Why it matters
It turns regional anaesthesia from an acute-pain choice into a long-term outcome decision.
Don't overread it
The certainty of evidence is low, and the neuraxial-versus-peripheral ranking rests on low to very low certainty network estimates.
The statistics, in plain English
A risk ratio of 0.73 means about 27% fewer patients with chronic pain. Low certainty means further trials could change the size of the effect, though the direction has been consistent.
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