Comparison Of Erector Spinae Plane Block And Thoracic Paravertebral Block For Postoperative Analgesia After Video-assisted Thoracic Surgery

Objective:A meta-analysis was conducted to compare the clinical efficacy and safety of erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery.Method:By computer search CNKI,Wanfang Data,VIP database,Web of Sci-ence,Pub Med,Google Scholar,the Cochrane library and Embase for ran-domized controlled trials which compared ESPB and TPVB for postoper-ative analgesia after video-assisted thoracic surgery.Two reviewers independently screened the literature and used Rev Man5.3 software to perform a meta-analysis of the included literature.The primary outcomes included 1 hour,12 hours,24 hours,48 hours static and cough pain score and 24 hours morphine consumption.Secondary outcomes included nerve block operation time,the numbers of postoperative remedial analgesia and the incidence of postoperative nausea and vomiting.Main results:Fifteen randomized controlled trials were eventually included.A total of 987 patients were enrolled(ESPB group 494 patients,TPVB group 493patients).The results of meta-analysis showed that there were considered to demonstrate statistically significant differences between ESPB and TPVB in the cough pain scores at 12h and 24h after surgery[12h:SMD=0.20,95%CI(0.05,0.36),p=0.008 I~2=35%;24h:SMD=0.38,95%CI(0.18,0.58),p=0.0001,I~2=7%];There were no statistical difference in cough pain score at 1h and 48h after surgery(p>0.05);No statistical differ-ence were found in static state pain scores between ESPB and TPVB at1h,12h,24h and 48h after surgery(p>0.05);Differences were considered to be significant between ESPB and TPVB in the operation time of nerve block[MD=-3.33,95%CI(-5.46,-1.20),p=0.002,I~2=97%];Statistical dif-ference was considered significant between ESPB and TPVB in the fre-quency of postoperative remedial analgesia[RR=1.70,95%CI(1.29,2.25),p=0.0002,I~2=21%];No statistical difference was found between ESPB and TPVB in the 24 hours total morphine consumption after operation(p>0.05);No statistical difference was found between ESPB and TPVB in the incidence of postoperative nausea and vomiting between ESPB and TPVB groups(p>0.05).Conclusion:Both ESPB and TPVB can relieve the static state pain after video-assisted thoracic surgery.In addition,TPVB has a more exact postoperative analgesic effect on coughing than ESPB,while ESPB requires a shorter operating time than TPVB.