Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis

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. Graphical abstract.

Medienart:	E-Artikel

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	Zur Gesamtaufnahme - volume:38
Enthalten in:	Surgical endoscopy and other interventional techniques - 38(2024), 4 vom: 02. Feb., Seite 1844-1866

Sprache:	Englisch

Beteiligte Personen:	Lohmöller, Katharina [VerfasserIn] Carstensen, Vivian [VerfasserIn] Pogatzki-Zahn, Esther M. [VerfasserIn] Freys, Stephan M. [VerfasserIn] Weibel, Stephanie [VerfasserIn] Schnabel, Alexander [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

BKL:	44.87
Themen:	Pain management Postoperative pain Regional anaesthesia

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© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:	10.1007/s00464-023-10667-w

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PPN (Katalog-ID):	SPR055331734