Researchers from Glasgow, who reviewed more than 100 trials, found that patients given regional anaesthesia had a reduced risk for chronic post-surgical pain for up to 12 months, especially after undergoing breast, knee and thoracic procedures, reports Medscape.
The team, led by Martin Taylor-Rowan of the University of Glasgow, had conducted a systematic review and meta-analysis of randomised trials to assess whether regional anaesthesia reduced the risk for the long-term use of opioids or the incidence of chronic post-surgical pain.
They included 158 trials published between 2000 and 2025 involving 18 794 adults (mean age 55) who underwent surgeries like mastectomy, thoracotomy, and joint replacement.
Primary outcomes were the incidence of chronic post-surgical pain and long-term use of opioids, defined as at least three months after surgery, with follow-up up to two years.
Researchers compared neuraxial or peripheral regional techniques with no block, a placebo, or other regional blocks.
Heterogeneity (I2) and the certainty of evidence were assessed. The risk for bias was graded as high in 51% of trials, low in 30%, and unclear in 19%.
In their findings, published online in the British Journal of Anaesthesia, regional anaesthesia was linked to a 27% reduced risk for chronic post-surgical pain compared with no regional anaesthesia (risk ratio [RR], 0.73; 95% CI, 0.67-0.80; 79 trials; I2, 59.1%), with low certainty of evidence. The effect persisted up to 12 months but not at 24 months.
On pooling trials by procedure, the team said, regional anaesthesia was linked to a significantly reduced risk for chronic pain after mastectomy, thoracotomy, video-assisted thoracoscopic surgery and knee arthroplasty, with I2 up to 66.3%.
The meta-analysis found that neuraxial blocks were linked to a lower risk for chronic pain than peripheral blocks after thoracotomy (RR, 0.64 vs 0.84; I2, 19.6%) and video-assisted thoracoscopic surgery (RR, 0.60 vs 0.77; I2, 30%).
They found that regional anaesthesia did not significantly reduce the long-term use of opioids (seven trials).
“Low-certainty evidence supports the use of regional anaesthesia as an effective method for reducing the incidence of CPSP (chronic post-surgical pain) after surgery,” they reported.
Limitations
Trials often excluded patients with high risk for chronic post-surgical pain at baseline, and most trials had small sample sizes. Additionally, said the researchers, heterogeneity in defining outcome and methods for pain assessment may have weakened the analysis.
Study details
Regional anaesthesia and chronic post-surgical pain: a systematic review and network meta-analysis
Martin Taylor-Rowan, Iain Mactier, Clareece Nevill et al.
Published in British Journal of Anaesthesia on 6 July 2026
Abstract
Background
Pain arising after surgery and persisting beyond 3 months is termed ‘chronic post-surgical pain’ (CPSP). Prevention of CPSP is a research priority. Our objectives were to assess whether regional anaesthesia can reduce the incidence of CPSP and long-term opioid use and to determine which factors influence its effectiveness.
Methods
We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-compliant systematic review and network meta-analysis of randomised controlled trials assessing the effectiveness of regional anaesthesia for reduction of CPSP. We searched various databases up to October 2025. We performed pairwise meta-analysis and network meta-analysis to determine whether type, timing and method (catheter or single injection) of regional anaesthesia influenced the incidence of CPSP. We investigated the effect of surgery type, baseline risk, and sex via meta-regression. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE)/ Confidence In Network Meta-Analysis (CINeMA) to assess certainty of evidence.
Results
We included 158 randomised controlled trials involving 18 794 subjects. Overall, regional anaesthesia reduced the incidence of CPSP compared with no block (risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.67–0.80), with effects observed up to 12 months after surgery. Reductions in CPSP were also observed within specific surgery types, including mastectomy (RR: 0.69, 95% CI: 0.59–0.79), thoracotomy (RR: 0.72, 95% CI: 0.55–0.96), video-assisted thoracoscopic surgery (RR: 0.73, 95% CI: 0.56–0.96), and knee arthroplasty (RR: 0.71, 95% CI: 0.52–0.97). Opioid use was not statistically significantly different between groups (RR: 0.88, 95% CI: 0.61–1.28). CPSP evidence was low certainty; opioid use was very low certainty. Network meta-analysis suggested that neuraxial techniques reduced the incidence of CPSP more effectively than peripheral techniques after thoracotomy (neuraxial RR: 0.64 95% CI: 0.49–0.83; peripheral RR: 0.84, 95% CI 0.73–0.96) and video-assisted thoracoscopic surgery (neuraxial RR: 0.60, 95% CI: 0.45–0.80; peripheral RR: 0.77, 95% CI: 0.63–0.94), compared with no block. Differences in effectiveness based on administration time point and method of administration varied by surgery type. Network meta-analysis evidence was low to very low certainty. Meta-regression showed no significant effect of surgery type, sex or baseline risk.
Conclusions
Our findings indicate that regional anaesthesia reduces the incidence of CPSP for up to 12 months after surgery. The effectiveness of regional anaesthesia was influenced by the type of regional technique used, whereas the type of surgery, sex, or baseline risk did not have a significant impact.
Medscape article – Regional Anaesthesia May Cut Risk for Post-Op Chronic Pain (Open access)
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