Evidence for regional anesthesia in preventing chronic postsurgical pain

Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for mitigating CPSP remain uncertain. Regional anesthesia is a potentially beneficial yet debated intervention for mitigating the risk of CPSP. This review will delve into the mechanistic aspects of regional anesthesia and critically assess the current literature to provide a thorough understanding of its role and effectiveness. The incidence and severity of CPSP are linked to nerve damage, neuroplastic changes and immunological responses. Although numerous mechanisms contributing to CPSP have been identified, translational research is sparse, and findings are often inconsistent. Evidence suggests that regional anesthetic techniques could have a role in reducing CPSP risk across various clinical scenarios. Techniques studied include wound infiltration, peripheral nerve blocks, fascial plane blocks, thoracic paravertebral blocks and epidural anesthesia. Current data indicate that epidural anesthesia might decrease CPSP risk following thoracotomy, wound infiltration may be effective after major breast surgery and cesarean delivery, and serratus anterior plane block or pectoralis/interpectoral plane blocks might be beneficial in breast surgery. However, the existing evidence is limited and marked by several constraints especially the multifactorial causes, underscoring the need for further research in this area.