This project is ongoing and does not have results.
The Patient-Centered Outcomes Research Institute (PCORI) is partnering with the Agency for Healthcare Research and Quality (AHRQ) to develop a systematic evidence review on Peripheral Nerve Blocks for Postoperative Pain Management. The American Society of Anesthesiologists (ASA) nominated the topic to PCORI in anticipation of the systematic evidence review informing a future guideline.
Millions of elective surgeries are performed in the United States annually. Postoperative pain is a major concern for most surgical patients and their providers. Inadequate postoperative pain management is associated with increased morbidity, delayed recovery and the potential for long-term opioid use and dependence, ultimately impacting quality of life. Conversely, optimal postoperative pain management can improve patient outcomes, reduce psychological distress and facilitate recovery.
Multimodal analgesic strategies to manage postoperative pain exist and include opioid or non-opioid analgesics (e.g., nonsteroidal anti-inflammatory drugs, acetaminophen), regional anesthesia (e.g., peripheral nerve and neuraxial blocks, local infiltration) and non-pharmacologic interventions (e.g., music, acupuncture, transcutaneous electrical nerve stimulation). However, opioids remain the mainstay in postoperative pain management in the United States despite the increased risk for postoperative morbidity and mortality from opioid-related adverse events and the potential for long-term postoperative opioid use.
Peripheral nerve blocks are a type of regional anesthesia in which anesthetic is injected near a specific nerve or bundle of nerves to block pain. Peripheral nerve blocks may be administered at different time points during surgery to manage postoperative pain. These interventions have the potential to reduce perioperative opioid use and its associated adverse effects; however, providers require specialized training to administer them, and this may limit wider use. While multiple guidelines include recommendations (based on moderate to strong evidence) for incorporating non-opioid analgesics in perioperative multimodal analgesia, there are no comparable, recent clinical guidelines around employing peripheral nerve blocks, except in orthopedic surgery. Updated, evidence-based guidance could lead to wider training and implementation initiatives for this anesthetic technique in perioperative multimodal analgesia.
Recent systematic reviews of peripheral nerve blocks for postoperative pain have focused narrowly on specific types of surgeries and/or types of peripheral nerve blocks, with a large body of evidence synthesized for orthopedic surgical populations. However, no recent systematic review has evaluated studies of diverse peripheral nerve blocks across different surgeries. Furthermore, a moderate volume of new research on peripheral nerve blocks has accumulated in the last five years. A new systematic review is needed to examine the benefits and harms of peripheral nerve blocks for diverse surgical populations excluding orthopedics. This review would facilitate ASA’s ongoing efforts to update their 2012 clinical practice guideline on acute pain management in the perioperative setting.
Proposed Key Questions (KQs)
KQ: In surgical patients, what are the effectiveness, comparative effectiveness and harms of peripheral nerve blocks for managing postoperative pain and its sequelae—including opioid use?
How do findings vary by patient clinical (e.g., comorbid conditions, type of surgery) or demographic characteristics (e.g., age, sex, race/ethnicity, socioeconomic status), provider characteristics (e.g., Doctor of Medicine, Certified Registered Nurse Anesthetist), or setting (e.g., teaching hospital, rural/urban, inpatient/ambulatory)?