Efficacy and safety of general anesthesia combined with paravertebral blockade on postoperative recovery in patients undergoing pulmonary surgery: a systematic review and meta-analysis

BACKGROUND: Research on analgesic effect, stress response, and lung function of thoracic epidural blockade (TEB) and paravertebral blockade (PVB) are inconsistent. This study conducted a meta-analysis of related literature, aiming at comparing the clinical efficacy and safety of two analgesic methods, and providing scientific evidence-based basis for clinical choice of analgesic methods. METHODS: PubMed, Embase, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, VIP, and Foreign Medical Journal Full-Text Service were searched. Keywords were as follows: thoracic epidural block (TEB), paravertebral blockade (PVB), paravertebral catheterization, thoracotomy, and analgesia. Two professionals independently screened documents and extracted data, and used Cochrane System Evaluator Manual (version 5.1.0) to repeatedly assess the bias risk of the documents included in the study. RESULTS: A total of 9 articles were included. Of the 9 RCTs in the present study, 5 described the allocation concealment in detail, 9 described the correct random allocation method, and 1 did not use the blind method. The visual simulation scores of the PVB group and TEB group at 24 and 48 h were not statistically significant [mean difference (MD): −0.17, 95% confidence interval (CI): −0.43 to 0.08, P=0.18; MD: 0.21, 95% CI: −0.06 to 0.48, P=0.13]. The fixed-effects model was used to analyze the incidence of hypotension, nausea, vomiting, and urinary retention. The results showed that there was significant difference between the PVB group and TEB group [hypotension: relative risk (RR): 0.16, 95% CI: 0.06–0.46, P=0.0006; nausea: RR: 0.40, 95% CI: 0.25–0.66, P=0.0002; vomiting: RR: 0.23, 95% CI: 0.06–0.87, P=0.03; urinary retention: RR: 0.36, 95% CI: 0.15–0.87, P=0.02]. DISCUSSION: The meta-analysis confirmed that PVB has the same analgesic effect and postoperative pulmonary function as epidural blockade in open thoracotomy lung surgery. In addition, PVB can reduce the incidence of analgesia-related complications and postoperative chronic pain.