Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Jiang, Tao; Mo, Xuan; Zhan, Ruonan; Zhang, Yi; Yu, Yang

doi:10.5114/wiitm.2023.124407

Cited by 3 publications

(5 citation statements)

References 69 publications

(60 reference statements)

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“…Compared to thoracic epidural analgesia, PVB has demonstrated its ability to reduce pain scores, opioid consumption, major postoperative complications, and referrals to the ICU [8,9]. Additionally, PVB has been associated with shorter hospital LOS, and improved patient comfort and recovery [6]. However, PVB is not entirely devoid of risks, which include pneumothorax, hypotension (in case of bilateral PVB), dural puncture, epidural abscess, or hematoma [2 ▪ ].…”

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

“…Nonetheless, Feray et al [2 ▪ ] have appointed the ESPB as the ‘apex block’ for VATS. This block requires the injection of local anesthetics between the erector spinae muscles and the transverse processes, leading to cranio-caudal spread across multiple vertebral levels [2 ▪ ,6]. Potential adverse events include pneumothorax and local anesthetic systemic toxicity (LAST).…”

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

“…However, no difference in mobilization times were observed between the groups [13]. Regarding the comparison between SAPB and ESBP, the latter reduced opioids and lowered pain scores, but its impact on recovery remains unclear, as there was no difference in hospital LOS [2 ▪ ,6,14]. Comparative studies of ICNB to SAPB or ESPB have generated conflicting results [5 ▪▪ ].…”

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

“…Additionally, SAPB has shown hemodynamic stability during surgery, making it advantageous over PVB or thoracic epidural block [17]. However, it appears to be inferior compared to PVB or ESPB in terms of hospital LOS [6].…”

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

“…Blocking signal transduction in these nerves allow for somatic analgesia in the thoracic wall. Various regional techniques such as paravertebral block (PVB), erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and intercostal nerve block (ICNB) have been described to achieve perioperative analgesia [2 ▪ ,5 ▪▪ ,6]. However, treating visceral pain, characterized by dull inspiratory pain, remains a complex issue, and systemic (non)opioid agents are employed, with varying success, to complement regional techniques [5 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

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Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Hoogma,

Brullot,

Coppens

2023

Current Opinion in Anaesthesiology

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Purpose of review Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery. Recent findings Continuous advancements in surgical techniques have led to a reduction in surgical trauma. However, managing perioperative pain remains a major challenge, impeding postoperative recovery. The traditional neuraxial technique is now deemed outdated for minimally invasive thoracic surgery. Instead, newer regional techniques have emerged, and traditional approaches have undergone (re-)evaluation by experts and professional societies to establish guidelines and practices. Assessing the quality of recovery, even after discharge, has become a crucial factor in evaluating the effectiveness of these strategies, aiding clinicians in making informed decisions to improve perioperative care. Summary In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.

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Section: Regional Analgesic Strategiesmentioning

confidence: 99%

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

Section: Regional Analgesic Strategiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Hoogma,

Brullot,

Coppens

2023

Current Opinion in Anaesthesiology

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Chest Wall and Abdominal Blocks for Thoracic and Abdominal Surgeries: A Review

Sharma,

Damiano,

Al-Saidi

et al. 2023

Curr Pain Headache Rep

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Comparison of erector spinae plane block and serratus anterior plane block for postoperative analgesia in uniportal thoracoscopic lobectomy: a randomized controlled trial

Wu,

Xu,

Chen

et al. 2023

BMC Anesthesiol

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Background Postoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies. Methods A randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events. Results No significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015). Conclusions In patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group. Trial registration The study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).

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Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Cited by 3 publications

References 69 publications

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery

Chest Wall and Abdominal Blocks for Thoracic and Abdominal Surgeries: A Review

Comparison of erector spinae plane block and serratus anterior plane block for postoperative analgesia in uniportal thoracoscopic lobectomy: a randomized controlled trial

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