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. 2022 Jun;75(3):231-244.
doi: 10.4097/kja.21330. Epub 2021 Oct 13.

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

Yumin Jo  1   2 , Seyeon Park  3 , Chahyun Oh  1   2 , Yujin Pak  1   2 , Kuhee Jeong  1 , Sangwon Yun  1   2 , Chan Noh  1   2 , Woosuk Chung  1   2 , Yoon-Hee Kim  1   2 , Young Kwon Ko  1   2   4 , Boohwi Hong  1   2   4
Affiliations

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

Yumin Jo et al. Korean J Anesthesiol. 2022 Jun.

Abstract

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 (NMA).

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 (1391 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.

Keywords: Nerve block; Network meta-analysis; Opioid analgesics; Postoperative pain; Review; Video-assisted thoracic surgery.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Study flow diagram.
Fig. 2.
Fig. 2.
Assessment of risk of bias of included studies. The overall quality of the included studies were deemed satisfactory.
Fig. 3.
Fig. 3.
Network plots and forest plots for the network meta-analysis. (A) opioid consumption in the first 24 h post-operation, (B) early postoperative period (up to 6 h) pain scores, (C) middle postoperative period (6–18 h) pain scores, and (D) late postoperative period (18–24 h) pain scores. The mean difference (MD) and 95% CI are shown. ESPB: erector spinae plane block, INB: intercostal nerve block, SPB: serratus plane block, TPVB: thoracic paravertebral block.
See this image and copyright information in PMC

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