{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:47:15Z","timestamp":1792374435835,"version":"4.4.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This systematic review aims to clarify how combining short\u2010 and long\u2010acting local anaesthetics (LA) affects onset time and duration in peripheral nerve blocks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included randomised controlled trials comparing adults undergoing peripheral nerve blocks with combined short\u2010 and long\u2010acting LA with those receiving blocks performed with either a short\u2010 or long\u2010acting LA. The primary outcome was the duration of analgesia. Secondary outcomes included the duration of onset time. We conducted meta\u2010analyses, trial sequential analyses (TSA), risk of bias\u20102 and Grading Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 21 trials with 1539 participants. The combination of short and long\u2010acting LA reduced the duration of analgesia when compared with a long\u2010acting LA (mean difference (MD)\u2009=\u2009\u2212162\u2009min, 95% CI: \u2212246 to \u221279,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01, tau\u2009=\u2009181\u2009min,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996%, TSA\u2010adj. 95% CI: \u2212254 to \u221271, GRADE\u2009=\u2009moderate). The combination increased the duration of analgesia when compared with short\u2010acting LA (MD\u2009=\u2009216\u2009min, 95% CI: 163\u2013269,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01, TSA\u2010adj. 95% CI: 150 to 282, GRADE\u2009=\u2009moderate). Combining short and long\u2010acting LA reduced the duration of onset time (MD\u2009=\u2009\u22128.0\u2009min, 95% CI: \u221211.5 to \u22124.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01, tau\u2009=\u20097.8\u2009min,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998%, TSA\u2010adj. 95% CI: \u221211.8 to \u22124.3, GRADE\u2009=\u2009low) when compared with long\u2010acting LA. In contrast, the duration of onset time was increased (MD\u2009=\u20091.7\u2009min, 95% CI: 0.2\u20133.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03, TSA\u2010adj. 95% CI: 0.1\u20133.4, GRADE\u2009=\u2009low) when compared with short\u2010acting LA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our assessment suggested that combining short and long\u2010acting LA reduced block duration by 2\u00bd\u2009h compared with long\u2010acting LA and increased it by 3\u00bd\u2009h compared with short\u2010acting LA. The changes in duration of onset time were limited and likely not clinically relevant. Thus, using either long\u2010 or short\u2010acting LA alone may generally be sufficient for peri\u2010 and postoperative pain management, making the need for combination unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>This systematic review with meta\u2010analysis presents updated results for different outcomes related to use of combined shorter and longer acting local anaesthetics for anaesthesia nerve blocks. The authors thoughtfully interpret the clinical relevance of the different outcomes in the meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      PROSPERO identifier: CRD4202346821,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=468211\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=468211<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70141","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T09:11:28Z","timestamp":1761815488000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Combining Short\u2010 and Long\u2010Acting Local Anaesthetics in Peripheral Nerve Blocks\u2014A Systematic Review With Meta\u2010Analysis and Trial Sequential Analysis"],"prefix":"10.1111","volume":"70","author":[{"given":"Jens L.","family":"Temberg","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology Copenhagen University Hospital \u2013 North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanja","family":"Pisljagic","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Copenhagen University Hospital \u2013 North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias T.","family":"Steensb\u00e6k","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Copenhagen University Hospital \u2013 North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Yousef","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Copenhagen University Hospital \u2013 North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana C.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Copenhagen University Hospital \u2013 North Zealand  Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4510-5888","authenticated-orcid":false,"given":"Kai H. 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