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Balzani E, Rosboch GL, Ceraolo E, Lyberis P, Filippini C, Piccioni F, Guerrera F, Ruffini E, Pedoto A, Brazzi L. The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials. TUMORI JOURNAL 2023; 109:6-18. [PMID: 35361015 DOI: 10.1177/03008916221081891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Several peripheral regional anaesthesia (RA) techniques are commonly used in thoracic surgery even in the absence of precise indications regarding their effectiveness on postoperative pain management. OBJECTIVE This systematic review and meta-analysis aims to describe and evaluate the relative effectiveness of different peripheral regional blocks and systemic analgesia in the context of video-assisted thoracoscopic surgery (VATS) or thoracotomy. DESIGN Systematic review of randomized controlled clinical trials (RCTs) with meta-analyses. DATA SOURCES We searched PubMed and Embase for all RCTs comparing the 24 hour morphine equivalents (MMEs) consumption following peripheral regional blocks and systemic analgesia (SA). ELIGIBILITY CRITERIA We selected only RCTs including adult participants undergoing thoracic surgery, including esophagectomy and reporting on postoperative pain outcomes including 24 hour MMEs consumption. RESULTS Among the 28 randomized studies including adult participants undergoing thoracic surgery and reporting on 24 hour opioid consumption, 11 reporting a comparison of individual blocks with systemic analgesia were meta-analyzed. RA was effective for almost all peripheral blocks. Regarding intercostal block, its antalgic effect was not well evaluated SMD -1.57 (CI -3.88, 0.73). RA in VATS was more effective in reducing MMEs than thoracotomy SMD -1.10 (CI -1.78, -0.41). CONCLUSIONS RA is a useful choice in thoracic surgery. However, it is still not possible to determine the most appropriate block in the individual surgical settings to be performed due to RCTs paucity.
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Affiliation(s)
- Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Paraskevas Lyberis
- Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Claudia Filippini
- Clinical Statistics, Department of Surgical Sciences, University of Torino, Corso Bramante 88, Turin, Italy
| | - Federico Piccioni
- General and Specialistic Surgical Department, Anesthesia and Intensive Care Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Francesco Guerrera
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Enrico Ruffini
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Alessia Pedoto
- Clinical Attending Department of Anesthesia and CCM, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Luca Brazzi
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
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Liu J, Ma W, Huang Y, Liu H, Wu C. Prediction, prevention and management of new onset peri-operative atrial fibrillation and flutter in patients undergoing non-cardiac thoracic surgery: a narrative review. Minerva Anestesiol 2022; 88:490-498. [PMID: 35475332 DOI: 10.23736/s0375-9393.21.16034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peri-operative atrial fibrillation and flutter (POAF) is recognized as a common complication of non-cardiac thoracic surgery. It is associated with hemodynamic instability, prolonged hospital stay, a risk of stroke and increased risk of mortality. The potential pathogenesis for POAF after non-cardiac thoracic surgery is multifactorial and not fully understood yet. Evaluation of risk factors and prediction of POAF can be beneficial for prevention and management of POAF in patients undergoing non-cardiac thoracic surgery. In this article, we reviewed related studies in order to provide a practically and clinically applicable strategy for anesthesiologists to effectively predict, prevent and manage new onset POAF in patients undergoing non-cardiac thoracic surgery.
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Affiliation(s)
- Jie Liu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wuhua Ma
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yankui Huang
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huihui Liu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Caineng Wu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China -
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Guerra-Londono CE, Privorotskiy A, Cozowicz C, Hicklen RS, Memtsoudis SG, Mariano ER, Cata JP. Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2133394. [PMID: 34779845 PMCID: PMC8593761 DOI: 10.1001/jamanetworkopen.2021.33394] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The use of intercostal nerve block (ICNB) analgesia with local anesthesia is common in thoracic surgery. However, the benefits and safety of ICNB among adult patients undergoing surgery is unknown. OBJECTIVE To evaluate the analgesic benefits and safety of ICNB among adults undergoing thoracic surgery. DATA SOURCES A systematic search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library databases using terms for ICNB and thoracic surgery (including thoracic surgery, thoracoscopy, thoracotomy, nerve block, intercostal nerves). The search and results were not limited by date, with the last search conducted on July 24, 2020. STUDY SELECTION Selected studies were experimental or observational and included adult patients undergoing cardiothoracic surgery in which ICNB was administered with local anesthesia via single injection, continuous infusion, or a combination of both techniques in at least 1 group of patients. For comparison with ICNB, studies that examined systemic analgesia and different forms of regional analgesia (such as thoracic epidural analgesia [TEA], paravertebral block [PVB], and other techniques) were included. These criteria were applied independently by 2 authors, and discrepancies were resolved by consensus. A total of 694 records were selected for screening. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data including patient characteristics, type of surgery, intervention analgesia, comparison analgesia, and primary and secondary outcomes were extracted independently by 3 authors. Synthesis was performed using a fixed-effects model. MAIN OUTCOMES AND MEASURES The coprimary outcomes were postoperative pain intensity (measured as the worst static or dynamic pain using a validated 10-point scale, with 0 indicating no pain and 10 indicating severe pain) and opioid consumption (measured in morphine milligram equivalents [MMEs]) at prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours, and >72 hours). Clinically relevant analgesia was defined as a 1-point or greater difference in pain intensity score at any interval. Secondary outcomes included 30-day postoperative complications and pulmonary function. RESULTS Of 694 records screened, 608 were excluded based on prespecified exclusion criteria. The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded. All of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2] years; approximately 59% men and 41% women) were included in the qualitative analysis, and 59 studies (3325 patients) that provided data for at least 1 outcome were included in the quantitative meta-analysis. Experimental studies had a high risk of bias in multiple domains, including allocation concealment, blinding of participants and personnel, and blinding of outcome assessors. Marked differences (eg, crossover studies, timing of the intervention [intraoperative vs postoperative], blinding, and type of control group) were observed in the design and implementation of studies. The use of ICNB vs systemic analgesia was associated with lower static pain (0-6 hours after surgery: mean score difference, -1.40 points [95% CI, -1.46 to -1.33 points]; 7-24 hours after surgery: mean score difference, -1.27 points [95% CI, -1.40 to -1.13 points]) and lower dynamic pain (0-6 hours after surgery: mean score difference, -1.66 points [95% CI, -1.90 to -1.41 points]; 7-24 hours after surgery: mean score difference, -1.43 points [95% CI, -1.70 to -1.17 points]). Intercostal nerve block analgesia was noninferior to TEA (mean score difference in worst dynamic panic at 7-24 hours after surgery: 0.79 points; 95% CI, 0.28-1.29 points) and marginally inferior to PVB (mean score difference in worst dynamic pain at 7-24 hours after surgery: 1.29 points; 95% CI, 1.16 to 1.41 points). The largest opioid-sparing effect of ICNB vs systemic analgesia occurred at 48 hours after surgery (mean difference, -10.97 MMEs; 95% CI, -12.92 to -9.02 MMEs). The use of ICNB was associated with higher MME values compared with TEA (eg, 48 hours after surgery: mean difference, 48.31 MMEs; 95% CI, 36.11-60.52 MMEs) and PVB (eg, 48 hours after surgery: mean difference, 3.87 MMEs; 95% CI, 2.59-5.15 MMEs). CONCLUSIONS AND RELEVANCE In this study, single-injection ICNB was associated with a reduction in pain during the first 24 hours after thoracic surgery and was clinically noninferior to TEA or PVB. Intercostal nerve block analgesia had opioid-sparing effects; however, TEA and PVB were associated with larger decreases in postoperative MMEs, suggesting that ICNB may be most beneficial for cases in which TEA and PVB are not indicated.
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Affiliation(s)
- Carlos E. Guerra-Londono
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, University of Texas, Houston
| | | | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Rachel S. Hicklen
- Research Medical Library, MD Anderson Cancer Center, University of Texas, Houston
| | | | - Edward R. Mariano
- Department of Anesthesia, School of Medicine, Stanford University, Stanford, California
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, University of Texas, Houston
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
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Jo Y, Park S, Oh C, Pak Y, Jeong K, Yun S, Noh C, Chung W, Kim YH, Ko YK, Hong B. Regional analgesia techniques for video assisted thoracic surgery: a frequentist network meta-analysis. Korean J Anesthesiol 2021; 75:231-244. [PMID: 34638182 PMCID: PMC9171539 DOI: 10.4097/kja.21330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis. Methods We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24 h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0–6 h), middle (6–18 h), and late (18–24 h) periods. Results A total of 21 RCTs (1,391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD]: −13.2 mg, 95% CI [−16.2, −10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD: −1.6, 95% CI [−2.3, −0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not. Conclusions TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seyeon Park
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yujin Pak
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Kuhee Jeong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sangwon Yun
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chan Noh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Kwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.,Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.,Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
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Huan S, Deng Y, Wang J, Ji Y, Yin G. Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0237363. [PMID: 33017425 PMCID: PMC7535861 DOI: 10.1371/journal.pone.0237363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. METHODS The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. RESULTS A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). CONCLUSION Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.
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Affiliation(s)
- Sheng Huan
- Nanjing University of Chinese Medicine, Nanjing, Jangsu, China
| | - Youming Deng
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Jia Wang
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Yihao Ji
- Nanjing University of Chinese Medicine, Nanjing, Jangsu, China.,Department of Critical Medicine, The Second Hospital of Nanjing, Nanjing, Jangsu, China
| | - Guoping Yin
- Department of Anesthesiology, The Second Hospital of Nanjing, Nanjing, Jangsu, China
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