Sixty-five RCTs (4,841 patients, range 23 to 280) were included in the review. The median Jadad score was 3 points.
Knee surgery (17 RCTs): Five out of five studies found that single shot or continuous femoral nerve blockade was associated with significantly improved analgesia when compared with systemic opioid treatment or local infiltration analgesia. Two studies found that interventions that included femoral nerve blockade were associated with significantly fewer side effects when compared to control (continuous epidural analgesia). Two out of two studies found that sciatic nerve block combined with femoral nerve blockade was associated with significantly reduced pain scores when compared with single femoral nerve block. There was no evidence of a significant difference in analgesia outcomes when femoral nerve block was compared with fascia iliaca block.
Hip surgery (six RCTs): Findings were inconsistent in two studies that compared continuous psoas/lumbar plexus block with continuous epidural analgesia. One study that compared femoral nerve block, lumbar plexus nerve block and systemic opioids found that regional anaesthesia and analgesia techniques improved analgesia outcomes compared to opioids; lumbar plexus provided better analgesia than femoral nerve block. One study that compared lumbar plexus with femoral nerve block found that patients in the lumbar group had better function after surgery. Two studies found that fascia iliaca block was associated with significantly better analgesic outcomes than no regional anaesthesia.
Ankle and foot surgery (six RCTs): One study found that combined continuous femoral nerve block plus popliteal sciatic nerve block was associated with significantly improved analgesia compared with a single continuous popliteal sciatic nerve block. One study found that continuous sciatic nerve block was associated with a reduction in the requirement for morphine and fewer side effects when compared with morphine.
Shoulder surgery (nine RCTs): Three out of three studies that compared single shot with continuous regional techniques found that continuous therapy was associated with significantly better analgesia. Inconsistent results were found in four studies that compared various combinations of continuous interscalene block. Two out of two studies found that continuous interscalene block was associated with a reduction in pain when compared with local infiltration analgesia.
Arm surgery (three RCTs): One study found that ultrasound guided continuous infraclavicular blockade was associated with improved analgesia when compared with ultrasound guided continuous supraclavicular blockade. One other study found that ultrasound guided axillary plexus block was associated with improved analgesia when compared with general anaesthesia.
Chest wall surgery (three RCTs): One study found that paravertebral block was associated with significantly more morphine usage than continuous epidural analgesia. Two other studies found no overall significant differences when single shot paravertebral block was compared with continuous paravertebral block and when paravertebral block was compared with systemic analgesia.
Abdominal surgery (17 RCTs): Findings were inconsistent in studies that compared transversus abdominis plane blocks with placebo, depending on site of surgery (full details reported). Two studies of women who underwent caesarean section found that morphine provided significantly improved analgesia when compared with transversus abdominis plane blocks. Transversus abdominis plane blocks with ultrasound guidance were associated with significantly improved analgesia when compared with ilioinguinal block in one study but not when both treatments used ultrasound guidance. Three other studies reported analgesic benefits with use of ilioinguinal blocks. Three studies found analgesic benefits with use of paravertebral block.
Thyroid surgery: Four studies found that superficial cervical plexus block was associated with significantly improved analgesia when compared with placebo.