Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis

Abstract

Giacomo Scorsese,1,* Zhaosheng Jin,1,* Seth Greenspan,1 Christopher Seiter,1 Yujie Jiang,1,2 Michael B Huang,3 Jun Lin1 1Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA; 2Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, 98195-6540, USA; 3Health Sciences Library, Stony Brook University, Stony Brook, NY, 11794-8034, USA*These authors contributed equally to this workCorrespondence: Giacomo Scorsese, Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA, Tel [phone], Fax [phone], Email [email protected]: Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis.Methods: A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted.Results: We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = − 27MME, 95% CI = − 46.2 to − 9MME), ESP (MD = − 20MME, 95% CI – 33 to − 7.9MME), PVB (MD = − 15MME, 95% CI = − 26 to − 4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks.Conclusion: Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.Keywords: fascial plane blocks, thoracic epidurals, post-operative analgesia, postoperative nausea and vomiting, video assisted thoracoscopic surgery

Keywords

• fascial plane blocks
• thoracic epidurals
• post-operative analgesia
• postoperative nausea and vomiting
• video assisted thoracoscopic surgery