Regional Analgesia in Video-Assisted Thoracic Surgery: A Bayesian Network Meta-Analysis

Jingfang Lin, Yanling Liao, Cansheng Gong, Lizhu Yu, Fei Gao, Jing Yu, Jianghu Chen, Xiaohui Chen, Ting Zheng, Xiaochun Zheng, Jingfang Lin, Yanling Liao, Cansheng Gong, Lizhu Yu, Fei Gao, Jing Yu, Jianghu Chen, Xiaohui Chen, Ting Zheng, Xiaochun Zheng

Abstract

Background: A variety of regional analgesia methods are used during video-assisted thoracic surgery (VATS). Our network meta-analysis (NMA) sought to evaluate the advantages of various methods of localized postoperative pain management in VATS patients.

Methods: PubMed, the Cochrane Library, and EMBASE were searched from their date of inception to May 2021 for randomized controlled trials (RCTs) comparing two or more types of locoregional analgesia in adults using any standardized clinical criteria. This was done using Bayesian NMA.

Results: A total of 3,563 studies were initially identified, and 16 RCTs with a total of 1,144 participants were ultimately included. These studies, which spanned the years 2014 to 2021 and included data from eight different countries, presented new information. There were a variety of regional analgesia techniques used, and in terms of analgesic effect, thoracic epidural anesthesia (TEA) [SMD (standard mean difference) = 1.12, CrI (Credible interval): (-0.08 to -2.33)], thoracic paravertebral block (TPVB) (SMD = 0.67, CrI: (-0.25 to 1.60) and erector spinae plane block (ESPB) (SMD = 0.34, CrI: (-0.5 to 1.17) were better than other regional analgesia methods.

Conclusion: Overall, these findings show that TEA, TPVB and ESPB may be effective forms of regional analgesia in VATS. This research could be a valuable resource for future efforts regarding the use of thoracic regional analgesia and enhanced recovery after surgery.

Systematic review registration: Identifier [PROSPERO CRD42021253218].

Keywords: Bayesian network meta-analysis; element analysis of Bayesian network; post-operative pain; regional analgesia; thoracic surgery; video-assisted.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Lin, Liao, Gong, Yu, Gao, Yu, Chen, Chen, Zheng and Zheng.

Figures

FIGURE 1
FIGURE 1
Flow chart. TEA epidural block; TPVB paravertebral block; SABP serratus anterior plane block; ESPB erector spinae plane; ICNB intercostal nerve block; RCT, Randomized controlled trials. PRISMA flow diagram for the literature search with reasons for exclusion.
FIGURE 2
FIGURE 2
Network geometry.
FIGURE 3
FIGURE 3
Relative effect sizes of efficacy at post-treatment according to network meta-analysis. Treatments are orders in the rank of their chance of being the best treatment. For efficacy in post-treatment, standardized mean differences (SMDs) more than 0 favor the column-defining treatment. Significant superiority of locoregional analgesia for pain management after VATS.
FIGURE 4
FIGURE 4
The surface under the cumulative ranking curve (SUCRA) was presented as a simple numerical statistic, with cumulative ranking probability plots summarized for each treatment. A SUCRA with a higher value denotes a greater likelihood of a given treatment being in the top rank or highly effective, while zero indicates that the treatment is certain to be the worst. A surface under the cumulative ranking curve (SUCRA) line was drawn to rank locoregional analgesia for pain management.

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