Continuous peripheral nerve block compared with single-injection peripheral nerve block: A systematic review and meta-analysis of randomized controlled trials

Ann E. Bingham, Rongwei (Rochelle) Fu, Jean Louis Horn, Matthew S. Abrahams

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs. METHODS: We conducted a systematic review and meta-analysis of all prospective, randomized trials comparing cPNBs with siPNBs. We used a validated systematic search strategy to identify potentially eligible studies. For studies meeting inclusion criteria, methodologic quality was scored independently by 2 reviewers. Data from the studies were abstracted and pooled for meta-analysis. RESULTS: Compared with siPNBs, cPNBs were associated with a decreased rating of worst pain on postoperative day 0 (effect size [ES], -1.29; 95% confidence interval [CI], -2.19 to -0.40; P = 0.005), postoperative day 1 (ES, -1.87; 95% CI, -2.44 to -1.31; P <0.001), and postoperative day 2 (ES, -2.03; 95% CI, -2.78 to -1.290; P <0.001); decreased overall opioid use (ES, -15.70; 95% CI, -21.84 to -9.55; P <0.001); less nausea (ES, 0.633; 95% CI, 0.407-0.983; P = 0.043); and higher patient satisfaction scores (weighted mean difference, -2.04; 95% CI, 1.24-2.85; P <0.001). CONCLUSIONS: Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.

Original languageEnglish (US)
Pages (from-to)583-594
Number of pages12
JournalRegional Anesthesia and Pain Medicine
Volume37
Issue number6
DOIs
StatePublished - Nov 2012

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Nerve Block
Peripheral Nerves
Meta-Analysis
Randomized Controlled Trials
Injections
Confidence Intervals
Patient Satisfaction
Nausea
Opioid Analgesics
Pain
Postoperative Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Continuous peripheral nerve block compared with single-injection peripheral nerve block : A systematic review and meta-analysis of randomized controlled trials. / Bingham, Ann E.; Fu, Rongwei (Rochelle); Horn, Jean Louis; Abrahams, Matthew S.

In: Regional Anesthesia and Pain Medicine, Vol. 37, No. 6, 11.2012, p. 583-594.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND OBJECTIVES: Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs. METHODS: We conducted a systematic review and meta-analysis of all prospective, randomized trials comparing cPNBs with siPNBs. We used a validated systematic search strategy to identify potentially eligible studies. For studies meeting inclusion criteria, methodologic quality was scored independently by 2 reviewers. Data from the studies were abstracted and pooled for meta-analysis. RESULTS: Compared with siPNBs, cPNBs were associated with a decreased rating of worst pain on postoperative day 0 (effect size [ES], -1.29; 95{\%} confidence interval [CI], -2.19 to -0.40; P = 0.005), postoperative day 1 (ES, -1.87; 95{\%} CI, -2.44 to -1.31; P <0.001), and postoperative day 2 (ES, -2.03; 95{\%} CI, -2.78 to -1.290; P <0.001); decreased overall opioid use (ES, -15.70; 95{\%} CI, -21.84 to -9.55; P <0.001); less nausea (ES, 0.633; 95{\%} CI, 0.407-0.983; P = 0.043); and higher patient satisfaction scores (weighted mean difference, -2.04; 95{\%} CI, 1.24-2.85; P <0.001). CONCLUSIONS: Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.",
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