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KMID : 0356920220750030231
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Korean Journal of Anesthesiology
2022 Volume.75 No. 3 p.231 ~ p.244
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Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis
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Jo Yu-Min
Park Se-Yeon
Oh Cha-Hyun
Pak Yu-Jin
Jeong Ku-Hee
Yun Sang-Won
Noh Chan
Chung Woo-Suk
Kim Yoon-Hee
Ko Young-Kwon
Hong Boo-Hwi
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Abstract
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Background: Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis.
Methods: We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24 h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0?6 h), middle (6?18 h), and late (18?24 h) periods.
Results: A total of 21 RCTs (1,391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD]: ?13.2 mg, 95% CI [?16.2, ?10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD: ?1.6, 95% CI [?2.3, ?0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not.
Conclusions: TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.
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KEYWORD
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Nerve block, Network meta-analysis, Opioid analgesics, Postoperative pain, Review, Video-assisted thoracic surgery
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