The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Xiao-Long Liang, Ran An, Qi Chen, Hong-Liang Liu, Xiao-Long Liang, Ran An, Qi Chen, Hong-Liang Liu

Abstract

Background: To date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery.

Methods: We systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting.

Results: A total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1-2 hours and 4-6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I2 = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV).

Conclusion: Compared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

Keywords: meta-analysis; thoracic epidural anesthesia; thoracic paravertebral block; thoracoscopic surgery.

Conflict of interest statement

The authors report no conflicts of interest for this work.

© 2021 Liang et al.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Risk of bias assessment using Cochrane criteria.
Figure 3
Figure 3
Forest plot of postoperative scores for resting pain at 1–2 hours, 4–6 hours, 24 hours, and 48 hours.
Figure 4
Figure 4
Forest plot of postoperative scores for coughing pain at 1–2 hours, 4–6 hours, 24 hours, and 48 hours.
Figure 5
Figure 5
Forest plot of the subgroup analysis of postoperative scores for resting pain at 24 hours (A) and 48 hours (B).
Figure 6
Figure 6
Forest plot of the subgroup analysis of postoperative scores for coughing pain at 24 hours (A) and 48 hours (B).
Figure 7
Figure 7
Forest plot of postoperative 24-hour usage of morphine.
Figure 8
Figure 8
Forest plot of hypotension.
Figure 9
Figure 9
Forest plot of PONV.

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Source: PubMed

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