Efficacy of paravertebral block techniques in thoracic surgery

Abstract

Introduction: Postoperative pain in thoracic surgery in adults is usually severe, and to control it there are many analgesic methods that include paravertebral blockade (PVB). Until now, there is no clarity on which is the most effective technique to perform this blockade. Objective: To describe the different PVB techniques and its analgesic effect in thoracic surgery. Methods: A systematic review of the literature was performed. We included studies that analyzed patients in open chest surgery and used PVB as analgesic technique. The Cochrane and Grading of Recommendation Assessment, Development and Evaluation strategies were used to analyze biases and evidence. The results are presented graphically by means of a visual analog scale (VAS) pain and opioid consumption equivalent to morphine for each technique found. We summarize the results with a qualitative approach without meta-analysis. Results: A total of 38 articles were analyzed (2188 patients). 13 using PVB guided by surface anatomy (SA-PVB), 7 Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and the remaining using PVB performed under direct visualization by the surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and US-PVB, and greater than 5 in studies with S-PVB; however, opioid consumption in the postoperative period was similar between the techniques described. Conclusion: PVB can be performed through 4 techniques. Techniques of US-PVB or SA-PVB have shown better consistency to manage postoperative acute pain in thoracic surgery.