Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.

Specifically in:

• Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
• Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
• Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
• Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
• Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
• TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.

summary

• Antje Barreveld, Jürgen Witte, Harkirat Chahal, Marcel E Durieux, and Gary Strichartz.
• Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115-6110, USA.
• Anesth. Analg.. 2013 May 1;116(5):1141-61.

AbstractThe use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review, we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, we examined the effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

This article appears in the collections: Regional stuff and Meta-analyses.

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