Abstract
To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.
Highlights
No matter thoracic surgery or breast surgery, postoperative analgesia has always been the focus of attention of anesthesiologists
The analysis showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% confidence interval (CI) = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia
Compared with the traditional standard of epidural analgesia, it has the advantages of less effect on respiratory or circulation system and less postoperative complications such as epidural hematomas and irreversible neurological disorder [5,6], which can be applied to patients with coagulation dysfunction
Summary
No matter thoracic surgery or breast surgery, postoperative analgesia has always been the focus of attention of anesthesiologists. PVB and INB have been popular methods of postoperative analgesia in the recent years because of the popular use of ultrasound [4]. Compared with the traditional standard of epidural analgesia, it has the advantages of less effect on respiratory or circulation system and less postoperative complications such as epidural hematomas and irreversible neurological disorder [5,6], which can be applied to patients with coagulation dysfunction. Thoracic paravertebral space is a potential cavity on both sides of the vertebral body, which is wedge-shaped. Each thoracic paravertebral space is not directly connected, but when injected in the near middle part, the local anesthetics can spread cranially and caudally through loose connective tissue [9]. A minority of the injected local anaesthetic can spread laterally to the intercostal space and to the epidural space [10]
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