The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials

Balzani, Eleonora; Rosboch, Giulio Luca; Ceraolo, Edoardo; Lybéris, Paraskevas; Filippini, Claudia; Piccioni, Federico; Guerrera, Francesco; Ruffini, Enrico; Pedoto, Alessia; Brazzi, Luca

doi:10.1177/03008916221081891

Cited by 8 publications

(4 citation statements)

References 49 publications

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“…Recent meta-analysis in VATS have also confirmed the superiority in pain management with regional anesthesia techniques such as the ESP block over standard analgesic regimen with benefits in PONV reduction when using regional techniques. [ 10 – 12 ]…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

Clairoux,

Moore,

Caron-Goudreault

et al. 2024

BMC Anesthesiol

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Introduction There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery. Methods We conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects. Results There was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery. Conclusion Our multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.

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Section: Discussionmentioning

confidence: 99%

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

Clairoux,

Moore,

Caron-Goudreault

et al. 2024

BMC Anesthesiol

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“…This provides limited perspective on the efficacy of the various blocks compared to the current standard in post-operative analgesia. 61 Lin et al, who performed an analysis of 16 RCTs, found that TEA, PVB, and ESP offered better analgesia than other blocks when measured by 24-hour postoperative pain scores. 62 However, their study protocol included both single-shot blocks and those with a continuous peripheral nerve catheter, which produces confounding results in relative pain scores due to the continuous infusion of analgesic medications.…”

Section: Discussionmentioning

confidence: 99%

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

Scorsese¹,

Jin²,

Greenspan³

et al. 2023

JPR

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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. Methods: 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. Results: 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. Conclusion: 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.

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“… 18 Its efficacy for thoracic surgeries in the first 24 hours after surgery as a single shot has been proven in previous studies and meta-analyses. 19 , 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

“…18 Its efficacy for thoracic surgeries in the first 24 hours after surgery as a single shot has been proven in previous studies and metaanalyses. [19][20][21] We compared the continuous ultrasound-guided ESPB with ICNB to evaluate their analgetic efficacy in patients after lung cancer resection, representing our institution's first study of continuous ESPB in Slovenia. We present the following article in accordance with the CONSORT reporting checklist.…”

Section: Introductionmentioning

confidence: 99%

Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgery

Gams,

Bitenc,

Danojevic

et al. 2023

Radiology and Oncology

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Background A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided erector spinae plane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB). Patients and methods A prospective randomized-control study was performed to compare outcomes of patients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h. Results 60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21. 64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 vs. 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups. Conclusions In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative complications, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.

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The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials

Cited by 8 publications

References 49 publications

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

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

Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgery

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