Assessing advances in regional anesthesia by their portrayals in meta-analyses: an alternative view on recent progress

Abstract

BackgroundThe aim of this study was to delineate research reflecting advances in regional/local anesthesia where recent clinical progress was clearly defined by meta-analysis.MethodsWe conducted a search to identify all articles with meta-analyses of randomized clinical trials related to the field of regional/local anesthesia. From 279 titles, after multiple exclusions, 16 meta-analyses on important clinical practice developments with high potential for a positive conclusion on the effectiveness of the treatment were left for the assessment. The assessment was performed in two steps. The first step was related to verification of proof-of-concept: the effect is statistically reliable (p-value, effect size, heterogeneity across different RCTs) and the risk of bias not too high. The second step was devoted to attempts to form an opinion on the real clinical benefits of a new development.ResultsThe assessment revealed that seven recent developments passed the proof-of-concept step. At the same time, positive conclusion on real clinical benefits was reached only by one of these seven developments: ultrasound guidance for peripheral nerve blocks (at least with some of the blocks). Meaningful clinical improvements with other developments remains uncertain. The assessment of the relationships between analyzed advancements over the past 30 years and earlier similar developments indicated that their evolution was usually incremental. The most original advancement was found to be the introduction of the transversus abdominis plane block.ConclusionThe assessment of recent advances in regional/local anesthesia, based on the evaluation of related meta-analyses, revealed only incremental progress with mostly marginal benefits. The progress was the most notable with ultrasound guidance for some of peripheral nerve blocks.

Regional Anesthesia in Surgery and Intensive Care: Are We Doing Enough?

“…The last decades saw a growing interest in Regional Anesthesia (RA) techniques in both surgical and Intensive Care Unit (ICU) settings, as testified by the increasing number of meta-analyses on the matter [1]. It is relatively easy to find and demonstrate the various advantages of these anesthesia and analgesia techniques for soft outcomes, such as reduced post-surgical consumption of analgesic drugs [2], respiratory complications [3], infections and duration of recovery in surgical department or ICU [3,4].…”