Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis

Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thorac...

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Bibliographic Details
Published in:Journal of pain research 2023-01, Vol.16, p.707-724
Main Authors: Scorsese, Giacomo, Jin, Zhaosheng, Greenspan, Seth, Seiter, Christopher, Jiang, Yujie, Huang, Michael B, Lin, Jun
Format: Article
Language:English
Subjects:
Analgesics
Analysis
Anesthesia
Bias
Bupivacaine
Care and treatment
Chest tubes
Epidural
fascial plane blocks
General anesthesia
Intervention
Medical research
Medicine, Experimental
Meta-analysis
Narcotics
Original Research
Ostomy
Pain
Patient satisfaction
post-operative analgesia
postoperative nausea and vomiting
Regional anesthesia
thoracic epidurals
Thoracic surgery
video assisted thoracoscopic surgery
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Summary:Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis. A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted. We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = -27MME, 95% CI = -46.2 to -9MME), ESP (MD = -20MME, 95% CI -33 to -7.9MME), PVB (MD = -15MME, 95% CI = -26 to -4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks. Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.
ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S396530