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Continuous Peripheral Nerve Block Compared With Single-Injection Peripheral Nerve Block: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
  1. Ann E. Bingham, MD*,
  2. Rochelle Fu, PhD,
  3. Jean-Louis Horn, MD and
  4. Matthew S. Abrahams, MD
  1. From the *Department of Anesthesiology, Columbia University, New York, NY; and
  2. Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, OR.
  1. Address correspondence to: Matthew S. Abrahams, MD, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, UHS-2, Portland, OR 97239 (e-mail:{at}


Background and Objectives Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs.

Methods We conducted a systematic review and meta-analysis of all prospective, randomized trials comparing cPNBs with siPNBs. We used a validated systematic search strategy to identify potentially eligible studies. For studies meeting inclusion criteria, methodologic quality was scored independently by 2 reviewers. Data from the studies were abstracted and pooled for meta-analysis.

Results Compared with siPNBs, cPNBs were associated with a decreased rating of worst pain on postoperative day 0 (effect size [ES], −1.29; 95% confidence interval [CI], −2.19 to −0.40; P = 0.005), postoperative day 1 (ES, −1.87; 95% CI, −2.44 to −1.31; P < 0.001), and postoperative day 2 (ES, −2.03; 95% CI, −2.78 to −1.290; P < 0.001); decreased overall opioid use (ES, −15.70; 95% CI, −21.84 to −9.55; P < 0.001); less nausea (ES, 0.633; 95% CI, 0.407–0.983; P = 0.043); and higher patient satisfaction scores (weighted mean difference, −2.04; 95% CI, 1.24–2.85; P < 0.001).

Conclusions Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.

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  • The authors declare no conflict of interest.

  • Funding was received through the Integrated and Translational Training in Anesthesiology Research T32 training grant.