{
  "abstract": "Background and Aims Chronic post-surgical pain (CPSP) is pain that develops following surgery and persists beyond 3 months. CPSP is common and challenging to manage. Preventing its development has been identified as a research priority. We aimed to assess if regional anaesthesia reduces the risk of CPSP following a range of procedures.Methods We conducted a PRISMA-compliant systematic review and meta-analysis of randomised controlled trials (RCT) assessing effectiveness of regional anaesthesia for prevention of CPSP, conducted between 2000 to July 2024. We restricted trials to surgeries where chronic pain is common. Outcomes included incidence of CPSP and other adverse events. We investigated effect of surgical subtype via meta-regression.Results We included 138 RCTs involving 16387 participants. Pairwise meta-analysis revealed regional anaesthesia reduced incidence of CPSP following mastectomy (RR=0.70; 95%CI:0.59–0.82) and thoracotomy (RR=0.77; 95%CI:0.62–0.96) relative to placebo or no regional anaesthesia. There were no significant differences for caesarean (RR=0.82; 95%CI:0.52–1.29), knee arthroplasty (RR=0.74; 95%CI:0.36–1.53), open inguinal hernia (RR=0.83; 95%CI:0.32–2.15), video assisted thoracoscopy (RR=0.77; 95%CI:0.54–1.08), major lower limb amputation (RR=0.87; 95%CI:0.54–1.40), hip arthroplasty (RR=1.23; 95%CI:0.41–3.72), sternotomy (RR=0.66; 95%CI:0.00–16037.51), craniotomy (RR=0.36; 95%CI:0.08–1.58), or open laparotomy (RR=0.77; 95%CI:0.38–1.56). Meta-regression for subgroup differences was not statistically significant however (F(10,53)=0.35, p=0.96), suggesting the effect of regional anaesthesia on CPSP was broadly consistent across surgery types. There were significantly fewer adverse events reported in regional anaesthesia arms compared to placebo or no regional anaesthesia arms in 11/43 (26%) trials that recorded adverse events. Regional anaesthesia did not significantly increase adverse events in any trials.Conclusions Regional anaesthesia significantly reduces the risk of developing CPSP following mastectomy and thoracotomy. Surgery type was not significantly associated with effectiveness of regional anaesthesia in meta-regression. Regional anaesthesia may also reduce the incidence of adverse events. We will compare specific regional anaesthesia techniques and continuous local anaesthetic infusion versus single shot injection in future analysis of our data.",
  "authors": [
    {
      "affiliations": [
        "University of Glasgow, Glasgow, UK"
      ],
      "name": "Martin Taylor-Rowan"
    },
    {
      "affiliations": [
        "NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Iain Mactier"
    },
    {
      "affiliations": [
        "University of Glasgow, Glasgow, UK"
      ],
      "name": "Rachel Kearns"
    },
    {
      "affiliations": [
        "University of Glasgow, Glasgow, UK"
      ],
      "name": "Alan MacFarlane"
    }
  ],
  "title": "OP07 Regional anaesthesia for reducing the incidence of chronic post-surgical pain: preliminary data from systematic review and network meta-analysis",
  "uid": "1a59fbb2-c9a9-5d44-a132-808370c968bc"
}