Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis

Abstract

Objective To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. Methods 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. Results 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.

Comparison of the efficacy of ultrasound-guided erector spinae plane block and thoracic paravertebral block combined with intercostal nerve block for pain management in video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial

“…The intercostal nerves come from the anterior branch of the thoracic paravertebral nerve, it was performed primarily by surgeons at multiple levels of direct visualization. The block was considered easy, with relatively low side effects and have been used as an analgesic replacement to TPVB in VATS with beneficial effect [ 22 ]. Although ICNB has shown to lower pain scores in the early postoperative period, but its duration of action was limited.…”

Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

“…The ICNB involves injection of local anesthetic in the intercostal space inferior to the rib between the internal and innermost intercostal muscles (Figure 1) and can be performed percutaneously with landmark or ultrasoundguidance, or intraoperatively with direct or video visualization (100). Meta-analysis of ICNB versus PVB for thoracic and breast surgery showed that PVB was superior to ICNB with improved analgesia at one and 24 hours, lower opioid consumption, and potentially improved postoperative respiratory function (101). More recently, a large systematic review and meta-analysis demonstrated that ICNB has benefits including improved pain control and reduced opioid consumption in the first 24 hours after thoracic surgery compared to systemic therapy alone (102).…”

Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: a pilot randomized controlled trial

“…In addition, placement of both TEA and PVB requires appropriate discontinuation of anticoagulants. Intercostal nerve blocks (ICNBs) have been used as an analgesic alternative to TEA and PVB in VATS with beneficial effect [ 13 , 14 ]. However, although ICNBs have shown to lower pain scores in the early postoperative period [ 15 ], they have a limited duration of effect [ 16 ].…”