A Comparison of Analgesia After a Thoracoscopic Lung Cancer Operation with a Sustained Epidural Block and a Sustained Paravertebral Block: A Randomized Controlled Study

Huang, Qiao-Wen; Li, Jiabin; Huang, Ye; Zhang, Wenqing; Lü, Zhiwei

doi:10.1007/s12325-020-01446-3

Cited by 17 publications

(20 citation statements)

References 33 publications

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“…Finally, five eligible RCTs were included in the meta-analysis. [14][15][16][17][18] The five eligible articles were carefully reviewed; their characteristics are provided in Table 1. The RCTs enrolled a total of 458 patients, and the results were published between 2015 and 2020.…”

Section: Literature Search and Selection And Quality Assessmentmentioning

confidence: 99%

“…Intraoperative use of opioids may affect pain severity, especially in the early postoperative period, and we attempted a subgroup analysis by opioid dosage. In three studies, [16][17][18] intraoperative opioid dosage was recorded in detail, and there was no statistical difference in intra-group opioid dosage. The sample size was too small for subgroup analysis, so we could not rule out the influence of intraoperative opioid dosage on our results, which may be one of the sources of heterogeneity.…”

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confidence: 99%

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The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Liang¹,

An²,

Chen³

et al. 2021

JPR

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Background To date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. Methods We systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting. Results A total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1–2 hours and 4–6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I 2 = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV). Conclusion Compared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

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Section: Literature Search and Selection And Quality Assessmentmentioning

confidence: 99%

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confidence: 99%

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Liang¹,

An²,

Chen³

et al. 2021

JPR

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“…Thirty-one clinical trials were identified after excluding titles and abstracts. After removing unrelated and inappropriate trials, the remaining 16 trials 8,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] were included in the final analysis from 1999 to 2020 with 1,000 patients (518 patients received PVB and 482 patients received TEA). ►Fig.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…An approximate six studies published after 2013 were included in our meta-analysis, and the quality of these trials was high. 8,15,18,[26][27][28] Comparing to the former meta-analysis, we formulated more strict inclusion criteria and excluded intercostal analgesia 38 and rib trauma. 34 Therefore, this updated meta-analysis may be considered to be more persuasive.…”

Section: Discussionmentioning

confidence: 99%

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

Yan

et al. 2021

Thorac Cardiovasc Surg

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Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

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“…With vasoconstriction, the pulmonary blood pressure on the unventilated side cannot return to the heart for oxygenation, leading to an increased volume of venous blood and, thus, a decrease in oxygen partial pressure and saturation. Low blood oxygen content will lead to an increase in acidic substances that can cause serious damage to important organs, such as the kidneys and brain during the surgery[ 9 - 11 ]. The negative effect of anesthesia on immune function is a further concern, increasing the risk for postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients

Zhen¹,

Jin²,

Chen³

et al. 2022

WJCC

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BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block. AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice. METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020. Patients were randomly allocated to the peripheral + general anesthesia (observation) group ( n = 74) or to the general anesthesia (control) group ( n = 66). Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia, with those in the control group receiving an epidural block combined with general anesthesia. Measured outcomes included the operative and anesthesia times, as well as the mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO 2 ) measured before surgery, 15 min after anesthesia (T1), after intubation, 5 min after skin incision, and before extubation (T4). RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group (1.48 ± 0.43 mg, 760.50 ± 92.28 mg, and 72.50 ± 16.62 mg, respectively) than control group ( P < 0.05). At the four time points of measurement (T1 through T4), MAP and HR values were higher in the observation than control group (MAP, 90.20 ± 9.15 mmHg, 85.50 ± 7.22 mmHg, 88.59 ± 8.15 mmHg, and 90.02 ± 10.02 mmHg, respectively; and HR, 72.39 ± 8.22 beats/min, 69.03 ± 9.03 beats/min, 70.12 ± 8.11 beats/min, and 71.24 ± 9.01 beats/min, respectively; P < 0.05). There was no difference in SpO 2 between the two groups ( P > 0.05). Postoperative levels of epinephrine, norepinephrine, and dopamine used were significantly lower in the observation than control group (210.20 ± 40.41 pg/mL, 230.30 ± 65.58 pg/mL, and 54.49 ± 13.32 pg/mL, respectively; P < 0.05). Similarly, the postoperative tumor necrosis factor-α and interleukin-6 levels were lower in the observation (2.43 ± 0.44 pg/mL and 170.03 ± 35.54 pg/mL, respectively) than control group ( P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( ...

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A Comparison of Analgesia After a Thoracoscopic Lung Cancer Operation with a Sustained Epidural Block and a Sustained Paravertebral Block: A Randomized Controlled Study

Cited by 17 publications

References 33 publications

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients

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