Pre-Operative Selective vs Non-Selective α-Blockade in Pheochromocytoma–Paraganglioma Patients Undergoing Surgery: A Meta-Analysis

Abstract

The main objective of this systematic review and meta-analysis was to review, assess and report on the studies that have evaluated selective alpha blockade (SAB) vs. non-selective alpha blockade (NSAB) therapy in patients undergoing surgery for pheochromocytomas and paragangliomas (PPGL). We performed a systematic search of electronic databases. A meta-analysis was conducted to examine the effectiveness of the two blockades. RevMan 5.3 was used for the meta-analysis. Of the eight articles that met the inclusion criteria, there was only one randomized control trial. Meta-analysis showed that there was no significant difference between the groups SAB and NSAB with regard to intra-operative systolic blood pressure (SBP) >160 mm Hg (relative risk (RR) 0.95 [95% CI 0.57, 1.56] P = 0·83) and intra-operative vasopressor requirement (RR 1.10 [95% CI 0.96, 1.26] P = 0·16). Meta-analysis revealed that there was a significant difference between the groups (SAB vs NSAB) with respect to post-operative vasopressor requirement (RR 1.66 [95% CI 1.0, 2.74] P = 0·05). There was no significant difference between the groups with respect to post-operative complications (RR 0.84 [95% CI 0.58, 1.22] P = 0·36). In conclusion, as patients blocked selectively may have a higher incidence of vasodilator requirement intra-operatively, NSAB offers some haemodynamic advantage over SAB. However, NSAB’s real clinical benefit cannot be ascertained with the current studies as this difference did not result in any significant advantage over SAB with regard to morbidity or mortality.

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

“…In the present study we did not find differences in the rate of hypertensive crisis between patients treated with doxazosin and phenoxybenzamine. This is in line with Pisarska-Adamczyk et al [31], but contrary to the findings of two recent meta-analysis comparing SAB vs. NSAB, where patients pretreated with NSAB had substantially lower intraoperative maximum blood pressure [33] and required less frequent use of vasodilators during PPGL resection compared with those treated with SAB, without differences between groups in vasopressor necessity, postoperative complications or mortality [33,34]. Regarding this matter, only one randomized controlled trial has been published by Buitenwerf et al (PRE-SCRIPT trial) [35], concluding that phenoxybenzamine was more effective in preventing intraoperative hemodynamic instability.…”