Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis
Comparação das características do bloqueio de misturas de anestésicos locais de curta/intermediária e longa duração para bloqueio de nervo periférico: uma revisão sistemática e meta-análise
Cheng Lin, Ana Larissa Guerrero, Joshua Jesin, Rohin Tangri, Nasong Anthony Luginaah, Kamal Kumar, Christopher Hansebout
Abstract
Background
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.
Methods
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.
Keywords
Resumo
Introdução
Os resultados de Ensaios Clínicos Randomizados (RCTs) sobre o uso de Anestésicos Locais (LA) mistos são conflitantes. Conduzimos uma revisão sistemática e meta-análise para avaliar se o uso de LA mistos leva a um início mais rápido do bloqueio cirúrgico.
Métodos
Realizou-se uma revisão sistemática e meta-análise de RCTs. Foram pesquisadas as bases Medline e Embase, sem restrição de idioma, desde o início até 15 de junho de 2024. Os RCTs incluídos compararam LA mistos com LA de longa duração em pacientes adultos submetidos a cirurgias, avaliando o início ou a duração de bloqueios nervosos. O tempo até o início do bloqueio cirúrgico foi o desfecho primário. Utilizou-se a Ferramenta de Risco de Viés da Cochrane e a metodologia GRADE para avaliação da qualidade das evidências.
Resultados
Dezenove estudos, incluindo 1060 participantes, atenderam aos critérios de inclusão. Os LA mistos reduziram modestamente o tempo até o bloqueio cirúrgico (-8,4 minutos; IC 95% -12,0 a -4,8 minutos; p = 0,0001; I² = 0,99), a duração do bloqueio sensitivo (-226,2 minutos; IC 95% -352,2 a -100,1 minutos; p = 0,002; I² = 0,98) e a duração do bloqueio motor (-259,2 minutos; IC 95% -399,5 a -119,0 minutos; p = 0,003; I² = 0,98), mas não o tempo até a solicitação de analgesia (-130,5 minutos; IC 95% -265,9 a 4,9 minutos; p = 0,057; I² = 0,98). A pontuação GRADE variou de baixa a muito baixa.
Conclusão
As evidências disponíveis indicam que o uso de LA mistos reduz modestamente a latência do bloqueio cirúrgico, mas também encurta sua duração. Estudos futuros devem avaliar o papel dos LA mistos em bloqueios de membros inferiores e a dosagem ideal de LA de longa duração para equilibrar o início da ação e a duração da analgesia.
Palavras-chave
References
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Submitted date:
10/02/2024
Accepted date:
03/09/2025
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