The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review

Abstract

Summary Effective prevention of chronic postoperative pain is an important clinical goal, informed by a growing body of studies. Peri‐operative regional anaesthesia remains one of the most important tools in the multimodal analgesic toolbox, blocking injury‐induced activation and sensitisation of both the peripheral and central nervous system. We review the definition and taxonomy of chronic postoperative pain, its mechanistic basis and the most recent evidence for the preventative potential of multimodal analgesia, with a special focus on regional anaesthesia. While regional anaesthesia targets several important aspects of the mechanistic pathway leading to chronic postoperative pain, evidence for its efficacy is still mixed, possibly owing to the heterogeneity of risk profiles within the surgical patient, but also to variation in techniques and medications reported in the literature.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Pharmacogenomic assessments show promise in elucidating precision pain management [537,538]. Additional evaluation of the influence of perioperative analgesic strategies on the development of persistent postoperative pain and opioid use would be an invaluable contribution to the literature [2,50,539]. Implementation studies describing successful opioid stewardship programs should be pursued to address practice challenges and increase universal adoption [38,68,540].…”

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial

“…However, one should remember the possible side effects of intrathecally administered morphine, such as delayed respiratory depression (up to 24 h after administration), pruritus, sedative effect, nausea, and vomiting [22]. Limited numbers of clinical trials evaluate patient satisfaction with the chosen method of postoperative pain control, such as ITM following a cesarean section and its impact on persistent pain [8,23].…”

“…Another rarely assessed, but important aspect of patient quality of life following surgery is the occurrence of chronic postsurgical pain (CPSP), which is considered one of the most common surgery-related complications [23,27]. The definition of CPSP involves postsurgical pain of more than 3-months duration that is new when compared to the preoperative status, and the cause is not secondary to an identifiable reason such as infection [28].…”

“…Although the occurrence of CPSP following cesarean section is lower than for other types of surgery [2], the constant increase in the number of cesarean sections globally makes CPSP a possible growing problem [31]. To date, few studies have been published assessing the possible effect of regional anesthesia on the occurrence of CPSP in patients after cesarean section [2,9,23].…”

The Future of Pain Medicine

“…16 Generally, these mechanisms involve nociceptive, inflammatory, and neuropathic pain leading to both peripheral and central sensitization. 17 Certain surgeries such as limb amputation and thoracotomy have been associated with a greater incidence of persistent postsurgical pain (PPSP) that goes on to become a chronic pain condition. 18 The impact of genetics on pain and its treatment is an ongoing field of research.…”