Comparison Of Serratus Plane Block And Thoracic Paravertebral Block For Postoperative Analgesia After Thoracic Surgery:A Systematic Review And Meta-analysis

Object:Incomplete postoperative analgesia after thoracic surgery is an important cause of a series of postoperative complications.At present,there is a dispute between anterior serratus plane block and thoracic paravertebral nerve block in the efficacy of postoperative analgesia after thoracic surgery.The existing clinical randomized controlled trials including anterior serratus plane block and thoracic paravertebral nerve block were systematically evaluated,so as to have a more comprehensive understanding of the clinical effects of the two nerve block methods in postoperative analgesia after thoracic surgery.Method:A systematic literature search was conducted using online databases,including Pub Med,Google scholar,the Cochrane Library,Web of science,CNKI and Web of Science,from the date of the establishment of the database to 31 January 2022.A comprehensive search and screening of clinical randomized controlled trials comparing SAPB and TPVB for postoperative analgesia in thoracic surgery.Literature search,literature screening and data processing for the literature screening are all carried out by two independent researchers.Rev Man5.3 software was used for quality assessment and quantitative meta-analysis of the included literature.Main outcome indicators including 2 hours,12 hours,24 hours after 48 hours,when patients resting and activity of VAS score,postoperative analgesia pump for the first time press time.The secondary outcome indicators include:number of required for operation time,postoperative recovery nerve block analgesia,postoperative opioid consumption,nausea and vomiting related to the incidence of complications and so on.Main results:This study finally included 19 RCTs,a total of 1181 patients.Meta analysis showed that there was significant difference between SAPB and TPVB in the number of postoperative analgesia pump presses.[MD=-1.67,95%CI（3.18,-0.16）,P=0.03,I~2=98%]（Figure 4.14）.The operation time of SAPB nerve block was significantly shorter than that of TPVB,[SMD=-4.03,95%CI（-5.86,-2.21）,P<0.0001,I~2=96%]（Fig.4.12）.There was no significant difference in VAS score at rest and activity,time of first postoperative analgesia,dosage of opioids at 48 hours after operation,and incidence of nausea and vomiting at 2h,12h,24h and 48h after operation.Conclusion:In thoracic surgery,there is no significant difference between SAPB and TPVB in postoperative analgesic effect and PONV incidence,which can provide effective postoperative analgesia.However,the operation time of SAPB is significantly shorter than that of TPVB.SAPB is safer than TPVB.The incidence of complications such as pneumothorax and hypotension after SAPB is less than that of TPVB.