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Comparison of Various Regional Analgesia Methods for Postoperative Analgesic Effects in Video-assisted Thoracoscopic Surgery: A Systematic Review and Network Meta-analysis.

BACKGROUND
The optimal analgesia for video-assisted thoracoscopic surgery (VATS) is still unknown.


OBJECTIVES
Our aim was to conduct a network meta-analysis and systematic review to compare the efficacy of different analgesic strategies in VATS.


STUDY DESIGN
Bayesian network meta-analysis.


METHODS
We searched PubMed, Embase, Medline, Springer, Google Scholar, and Web of Science to evaluate all relevant randomized controlled trials that investigated the analgesic effects of different regional analgesia methods for VATS published through July 2021. After a comprehensive search of electronic databases, the following methods were identified: epidural analgesia (EA), local anesthetics (LA), superficial serratus anterior plane block (SSAPB), deep serratus anterior plane block (DSAPB), erector spinae plane block (ESPB), paravertebral block (PVB), and intercostal nerve block (ICNB). Primary outcomes were the visual analog scale score at rest, at 2 hours, 6 hours and 24 hours postoperatively. The secondary outcomes were postoperative analgesic consumption, incidence of nausea and emesis, and pruritus.


RESULT
Overall, 35 trials met our inclusion criteria. EA and PVB were relatively more advantageous in terms of analgesic effect at 2 hours and 6 hours postoperatively; the EA group was superior to the DSAPB, ESPB, and ICNB groups at 24 hours postoperatively. EA was found to be superior to other analgesia techniques for 24 hour postoperative analgesic consumption., PVB showed advantages in reducing postoperative nausea, emesis, and pruritus.


LIMITATIONS
Different concentrations and volumes of local anesthetics might affect the analgesic effects of the various analgesia techniques.


CONCLUSION
EA and PVB have certain advantages in analgesia, but the incidence of postoperative pruritus after EA is higher. At the same time, considering the risk of coagulation and puncture complications, PVB may be a better choice.