REVIEW   

Minerva Anestesiologica 2023 November;89(11):1042-50

DOI: 10.23736/S0375-9393.23.17510-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Erector spinae plane block versus paravertebral block for postoperative pain management in thoracic surgery: a systematic review and meta-analysis

Paolo CAPUANO ¹ ✉, Bethany A. HILEMAN ², Gennaro MARTUCCI ¹, Giuseppe M. RAFFA ³, Antonio TOSCANO ⁴, Gaetano BURGIO ¹, Antonio ARCADIPANE ¹, Mariusz KOWALEWSKI ^{5, 6, 7, 8}

¹ Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy; ² University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; ³ Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy; ⁴ Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza, University of Turin, Turin, Italy; ⁵ Department of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Center of Postgraduate Medical Education, Warsaw, Poland; ⁶ Department of Cardio-Thoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands; ⁷ Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; ⁸ Thoracic Research Center, Collegium Medicum, Innovative Medical Forum, Nicolaus Copernicus University, Bydgoszcz, Poland

INTRODUCTION: The 2018 guidelines for enhanced recovery in thoracic surgery recommend paravertebral block (PVB) for postoperative pain management. However, recent studies demonstrate that erector spinae plane block (ESPB) achieves similar postoperative pain control with reduced block-related complications.
EVIDENCE ACQUISITION: We conducted a meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and safety of ESPB versus PVB for pain management after thoracic surgery. PubMed, Embase, and Scopus were searched through December 2022 (PROSPERO registration - CRD42023395593). Primary outcomes were postoperative pain scores, resting at 6, 12, 24, and 48 hours, and at movement at 24 and 48 hours. Secondary outcomes included opioid consumption at 24 and 48 hours, and incidence of postoperative nausea and vomiting or block-related complications in the first 48 hours.
EVIDENCE SYNTHESIS: Ten randomized control trials enrolling a total of 624 total patients were included. There were no significant differences in pain scores, resting or at movement, at any time points except reduced resting pain scores at 12 hours with PVB (mean difference [MD]) 0.60, 95% confidence interval [CI] 0.32 to 0.88). Opioid consumption demonstrated no significant differences at 24 hours; PVB reduced opioid consumption at 48 hours (MD 0.40, 95% CI -0.09 to 0.89). There were no significant differences in postoperative nausea or vomiting. ESPB exhibited a nonsignificant trend toward reduced cumulative block-related complications (risk difference [RD] 0.05, 95% CI -0.10 to 0.00).
CONCLUSIONS: Compared with PVB, ESPB is safe and demonstrates no clinically significant differences in pain management after thoracic surgery.

KEY WORDS: Anesthesia; Thoracic surgery; Analgesia and anesthesia; Acute pain