Systematic Review and Meta-Analysis of Application of Ultrasound-Guided Thoracic Paravertebral Block in Clinical Surgical Treatment

Abstract

Aim: There is a lack of consensus regarding the efficacy of thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) for postoperative pain in randomized controlled trials (RCTs). The comparison of TPVB and ESPB was explored through a systematic review and meta-analysis (MA) of relevant RCTs.

Methods: A comprehensive search of relevant literature was conducted using databases such as PubMed, Embase, and MEDLINE, from 2019 to June 2024. The search utilized keywords such as "TPVB", "ESPB", and "postoperative analogy". Following the search, quality evaluation and extraction of outcome indicators were implemented. The software RevMan5.3 was employed for data analysis and evaluation.

Results: The analysis included 18 articles. In patients at rest, a significant difference in pain scores was observed between the TPVB group and the ESPB group at 1 h postoperatively, with a standardized mean difference (SMD) of -0.52 [95% confidence interval (CI): -0.88 to -0.16, p = 0.005]. In non-resting patients, there were significant differences in pain scores between TPVB and ESPB at 24 and 48 h postoperatively. At 24 h postoperatively, the SMD was -0.37 (95% CI: -0.69 to -0.05, p = 0.02), and at 48 h postoperatively, in the visual analog scale (VAS) subgroup, the SMD was -0.38 (95% CI: -0.65 to -0.11, p = 0.006). Furthermore, notable statistical variations were identified in the frequency of rescue analgesia required following surgery between TPVB and ESPB.

Conclusions: The meta-analysis indicated that lower clinical pain scores in non-resting states at 24 and 48 h post-surgery were associated with TPVB rather than ESPB. This finding was accompanied by a more discernible and accurate analgesic effect, as well as a significant reduction in the need for rescue analgesia following surgical procedures.