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

Abstract

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.

Anatomical classification and clinical application of thoracic paraspinal blocks

“…Moreover, contra-indications to thoracic epidural analgesia do not preclude PVBs in most cases. For thoracic surgeries, such as thoracotomies, PVBs provide better postoperative analgesia and lower opioid consumption than ESP blocks and RLBs [26][27][28]. Although conflicting results have been reported for breast cancer surgery [29], the analgesic efficacy of PVBs was found to be superior to that of ESP and other truncal blocks [7].…”

Erector spinae plane block versus thoracic paravertebral block for the prevention of acute postsurgical pain in breast cancer surgery: A prospective observational study compared with a propensity score-matched historical cohort

“…Of interest, there are some reports suggesting the efficacy of ESPB in preventing acute PSP in this indication; some of them are randomized. In three meta-analyses, researchers compared the effect of ESPB to that of TPVB, but 2 also included thoracic surgery patients [25,27]. One meta-analysis included patients undergoing total mastectomies and found no statistically significant difference in morphine consumption at 24 hours [24].…”

“…However, there is no large study comparing ESPB to TPVB for major breast surgery. The available studies comparing ESPB to TPVB have shown analyses of a relatively low number of patients, and their results are pooled in several meta-analyses that have shown conflicting results [24][25][26][27]. Thus, the role of ESPB in the strategy of analgesia for breast surgery is not clearly defined, and the comparison of ESPB performance with that of TPVB will provide some answers.…”

Meme Koruyucu Cerrahi’lerde Torakal Paravertebral ve Erektör Spina Plan Bloğunun Postoperatif Opioid Tüketimi ve Analjezi Etkinliğinin Karşılaştırılması

“…Geleneksel olarak TPVB'nin meme cerrahilerinde postoperatif akut ağrı kontrolünde etkinliği kabul edilmiştir (6,7). Buna rağmen daha deneyimli klinisyenler tarafından yapılması önerilir (8). Son yıllarda Erector Spina Plan Bloğu (ESPB) güvenli ve etkin bir yöntem olarak gündeme gelmiştir (9).…”

“…%6.41 bulunmuştur(19). Çalışmamızda POBK oranlarına bakıldığında TPVB ve ESPB yapılan hastalarda, yapılan metaanaliz ve çalışmalarla uyumlu olarak fark bulunmadı(8,12,21). Bu sonuç gruplar arasında klinik olarak anlamlı olmayan morfin tüketim miktarlarına bağlanabilir.…”