Thoracic Paravertebral Block Achieves Better Pain Control Than Erector Spinae Plane Block and Intercostal Nerve Block in Thoracoscopic Surgery: A Randomized Study

Turhan, Özlem; Sivrikoz, Nükhet; Sungur, Zerrin; Duman, Salih; Özkan, Berker; Şentürk, Mert

doi:10.1053/j.jvca.2020.11.034

Cited by 72 publications

(75 citation statements)

References 31 publications

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“…Among which, 86 duplicates were removed. Through thorough review of the titles, abstracts, and full texts of the research studies, 10 RCTs [18][19][20][21][22][23][24][25][26][27] enrolled a total of 726 patients, were eventually selected for the final analysis. The flowchart of the study selection is shown in Fig 1 . The selected studies were published between 2019 and 2020, and they were carried out in different countries, such as China, Turkey, Egypt, USA, and Japan.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The flowchart of the study selection is shown in Fig 1 . The selected studies were published between 2019 and 2020, and they were carried out in different countries, such as China, Turkey, Egypt, USA, and Japan. Six studies [18,19,21,[25][26][27] involved thoracic surgery, including five thoracoscopic surgery and one thoracotomy. The other four [20,[22][23][24] were conducted on adult females receiving breast surgery.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis

Xiong

Han²,

Zhao

et al. 2021

PLoS ONE

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Background Paravertebral block (PVB) is the most recognized regional anesthesia technique after thoracic epidural anesthesia for postoperative analgesia in thoracic and breast surgery. Erector spinae plane block (ESPB) is a recently discovered blocking technique, and it has evidenced excellent postoperative analgesia for breast and thoracic surgery with fewer adverse reactions. However, there are controversies about the postoperative analgesic effects of the two analgesic techniques. Objective To assess the analgesic effects of PVB versus ESPB in postoperative thoracic and breast surgery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up to April 5, 2021. The primary outcome was postoperative pain scores. Secondary outcomes included: opioid consumption, additional analgesia, postoperative nausea and vomiting (PONV) 24 hours post-operation, and the time required for completing block procedure. This study was registered in PROSPERO, number CRD42021246160. Results After screening relevant, full-text articles, ten randomized controlled trials (RCTs) that met the inclusion criteria were retrieved for this meta-analysis. Six studies involved thoracic surgery patients, and four included breast surgery patients. Thoracic surgery studies included all of the outcomes involved in this meta-analysis while breast surgery did not report pain scores at movement and additional analgesia in 24 hours post-operation. For thoracic surgery, PVB resulted in significant reduction in the following pain scores: 0–1 hours (MD = -0.79, 95% CI: -1.54 to -0.03, P = 0.04), 4–6 hours (MD = -0.31, 95% CI: -0.57 to -0.05, P = 0.02), and 24 hours (MD = -0.42, 95% CI: -0.81 to -0.02, P = 0.04) at rest; significant reduction in pain scores at 4–6 hours (MD = -0.47, 95% CI: -0.93 to -0.01, P = 0.04), 8–12 hours (MD = -1.09, 95% CI: -2.13 to -0.04, P = 0.04), and 24 hours (MD = -0.31, 95% CI: -0.57 to -0.06, P = 0.01) at movement. Moreover, the opioid consumption at 24 hours post-operation (MD = -2.74, 95% CI: -5.41 to -0.07, P = 0.04) and the incidence of additional analgesia in 24 hours of the postoperative course (RR: 0.53, 95% CI: 0.29 to 0.97, P = 0.04) were significantly lower in the PVB group than in the ESPB group for thoracic surgery. However, no significant differences were found in pain scores at rest at various time points postoperatively, and opioid consumption at 24 hours post-operation for breast surgery. The time required for completing block procedure was longer in the PVB group than in the ESPB group for thoracic and breast surgery, and the incidence of PONV between the two groups showed no significant difference. Conclusion The postoperative analgesic effects of PVB versus ESPB are distinguished by the surgical site. For thoracic surgery, the postoperative analgesic effect of PVB is better than that of ESPB. For breast surgery, the postoperative analgesic effects of PVB and ESPB are similar.

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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis

Xiong

Han²,

Zhao

et al. 2021

PLoS ONE

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“…INB can be performed easily with various techniques using ultrasonography or by blind technique. Also, direct injection inside of the thorax by thoracic surgeon is available [30]. INB would only result in segmental somatic nerve blockade, and thus multiple injections are essential for appropriate pain control.…”

Section: Discussionmentioning

confidence: 99%

“…17 [25][26][27][28]30,31,33,35,[37][38][39][40][41][42][43][44][45] RCTs reported opioid consumption and 18 [25,26,28,[30][31][32][33][34][35][36][38][39][40][41][42][43][44][45],…”

Section: Efficacy Outcomes (Network Meta-analysis)mentioning

confidence: 99%

“…16 [25,26,[28][29][30][31][32][33][34][35][38][39][40][41][42][43][44] , 17 [25][26][27]29,30,[33][34][35][36][38][39][40][41][42][43][44][45] RCTs reported pain score for each time period during the postoperative 24 hours. The networks for TPVB and Control were greater than the networks for other blocks, followed ESPB and Control.…”

Section: Efficacy Outcomes (Network Meta-analysis)mentioning

confidence: 99%

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Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Park

et al. 2022

Korean J Anesthesiol

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Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Chenesseau,

Fourdrain,

Pastene

et al. 2023

JAMA Surg

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ImportanceIn minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)–guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options.ObjectiveTo demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group.Design, Setting, and ParticipantsIn this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS).InterventionsPVB-VATS or PVB-US.Main Outcomes and MeasuresThe primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications.ResultsA total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: −5.4 mg; 95% CI, −∞ to −0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups.Conclusions and RelevancePVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours.Trial RegistrationClinicalTrials.gov Identifier: NCT04579276

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Thoracic Paravertebral Block Achieves Better Pain Control Than Erector Spinae Plane Block and Intercostal Nerve Block in Thoracoscopic Surgery: A Randomized Study

Cited by 72 publications

References 31 publications

Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis

Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

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