Meta analysis of ultrasound-guided posterior and paravertebral block for postoperative analgesia and adverse reactions in thoracic surgery

This article used meta-analysis and systematic evaluation methods to compare the analgesic effect and incidence of adverse reactions of ultrasound-guided posterior block (RLB) and paravertebral block (PVB) in patients undergoing thoracic surgery. Pub Med, Cochrane Library, EMBase, CNKI, Wanfang Database, Vip Database, and China Biomedical Full-text Database were searched from the establishment of the library to 2022-12-01, and randomized controlled trials (RCTs) on the analgesic effect of ultrasound-guided RLB and PVB in thoracic surgery were collected and compared. Among them, the patients in the control group used ultrasound-guided RLB composite general anesthesia, and the patients in the experimental group used ultrasound-guided PVB combined general anesthesia. The primary outcomes were 2h, 6h, 12h, 24h, and 48h postoperative resting state and motor state NRS scores; Secondary outcomes were the number of analgesia and the incidence of adverse effects such as nausea, vomiting, and dizziness after surgery. Data were meta-analysed using Rev Man 5.3 software. A total of 220 patients in 4 RCT studies were included, including 110 cases in the RLB block group and 110 cases in the PVB group. The results of meta-analysis showed that compared with the PVB group (control group), the NRS score in the RLB group (experimental group) at rest at 6(MD=0.45,95%CI 0.16~-0.75,P=0.003) hand 24 h (MD=0.26, 95%CI 0.05~0.47, P=0.01) and NRS at 24h (MD=0.25, 95%CI 0.02~-0.48, P=0.03) exercise were significantly increased. There were no significant differences in NRS scores of resting state at 2h (MD=0.32,95%CI -0.22~0.66,P=0.06), 12h (MD=0.17,95%CI -0.03~0.36,P=0.09) and 48h (MD=0.07,95%CI -0.09~0.24,P=0.37) after surgery, NRS scores of exercise status at 2h (MD=0.26,95%CI -0.68~0.17,P=0.24), 6h (MD=0.09,95%CI -0.22~0.40,P=0.57), 12h (MD=0.04,95%CI -0.25~0.32,P=0.80) and 48h (MD=0.04,95%CI 0.22~0.30,P=0.74) after surgery, the number of postoperative remedial analgesia (RR=1.12,95%CI 0.45~2.79,P=0.82), postoperative vomiting nausea (RR=0.64,95%CI 0.34~1.19,P=0.16), dizziness (RR=0.61,95%CI 0.22~1.64,P=0.32) and other adverse reactions. The available clinical evidence shows that ultrasound-guided PVB is better than RLB in the early postoperative (24h) analgesia of thoracic surgery, and there is no significant difference between the two in the long-term (48h) analgesia after surgery, and the incidence of adverse reactions such as nausea, vomiting and dizziness does not increase compared with RLB.