Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis
Introduction: Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block. Method: We conducted systemic review and meta-analysis of RCTs. Medlin...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
|
| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001425000338 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850042998711123968 |
|---|---|
| author | Cheng Lin Ana Larissa Guerrero Joshua Jesin Rohin Tangri Nasong Anthony Luginaah Kamal Kumar Christopher Hansebout |
| author_facet | Cheng Lin Ana Larissa Guerrero Joshua Jesin Rohin Tangri Nasong Anthony Luginaah Kamal Kumar Christopher Hansebout |
| author_sort | Cheng Lin |
| collection | DOAJ |
| description | Introduction: Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block. Method: We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality. Results: Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I2 = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I2 = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I2 = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I2 = 0.98). GRADE scoring ranged from low to very low. Conclusion: The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration. PROSPERO registration: CRD42024552801. |
| format | Article |
| id | doaj-art-a48c29bce5484570856347a93548fbc8 |
| institution | DOAJ |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-a48c29bce5484570856347a93548fbc82025-08-20T02:55:20ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-05-0175384461710.1016/j.bjane.2025.844617Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysisCheng Lin0Ana Larissa Guerrero1Joshua Jesin2Rohin Tangri3Nasong Anthony Luginaah4Kamal Kumar5Christopher Hansebout6Western University, Schulich School of Medicine, London, Ontario, Canada; Corresponding author.Western University, Schulich School of Medicine, London, Ontario, CanadaUniversity of Toronto, Department of Anesthesia, Toronto, Ontario, CanadaWestern University, Schulich School of Medicine, London, Ontario, CanadaWestern University, Schulich School of Medicine, London, Ontario, CanadaWestern University, Schulich School of Medicine, London, Ontario, CanadaWestern University, Schulich School of Medicine, London, Ontario, CanadaIntroduction: Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block. Method: We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality. Results: Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I2 = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I2 = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I2 = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I2 = 0.98). GRADE scoring ranged from low to very low. Conclusion: The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration. PROSPERO registration: CRD42024552801.http://www.sciencedirect.com/science/article/pii/S0104001425000338Conduction anesthesiaLocal anestheticNerve block |
| spellingShingle | Cheng Lin Ana Larissa Guerrero Joshua Jesin Rohin Tangri Nasong Anthony Luginaah Kamal Kumar Christopher Hansebout Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis Brazilian Journal of Anesthesiology Conduction anesthesia Local anesthetic Nerve block |
| title | Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis |
| title_full | Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis |
| title_fullStr | Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis |
| title_full_unstemmed | Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis |
| title_short | Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis |
| title_sort | comparing block characteristics of mixtures of short intermediate and long acting local anesthetics for peripheral nerve block a systematic review and meta analysis |
| topic | Conduction anesthesia Local anesthetic Nerve block |
| url | http://www.sciencedirect.com/science/article/pii/S0104001425000338 |
| work_keys_str_mv | AT chenglin comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT analarissaguerrero comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT joshuajesin comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT rohintangri comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT nasonganthonyluginaah comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT kamalkumar comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis AT christopherhansebout comparingblockcharacteristicsofmixturesofshortintermediateandlongactinglocalanestheticsforperipheralnerveblockasystematicreviewandmetaanalysis |