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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.21330    [Epub ahead of print]
Published online October 13, 2021.
Regional analgesia techniques for video assisted thoracic surgery: a frequentist network meta-analysis
Yumin Jo1,2, Seyeon Park3, Chahyun Oh1,2, Yujin Pak1,2, Kuhee Jeong1, Sangwon Yun1,2, Chan Noh1,2, Woosuk Chung1,2, Yoon-Hee Kim1,2, Young Kwon Ko1,2,4, Boohwi Hong1,2,4
1Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
2Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
3Department of Nursing, College of Nursing, Chungnam National University, Daejeon, Korea
4Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
Corresponding author:  Boohwi Hong, Tel: 82-42-280-7840, Fax: 82-42-280-7968, 
Email: koho0127@gmail.com
Received: 26 July 2021   • Revised: 28 September 2021   • Accepted: 12 October 2021
*Yumin Jo and Seyeon Park contributed equally to this study as co-first authors.
Abstract
Background
Various regional analgesia techniques are used to reduce postoperative pain in patients who received the video-assisted thoracic surgery (VATS). This study aims to determine the relative efficacy of the regional analgesic interventions for VATS using the network meta-analysis (NMA).
Methods
We searched Medline, EMBASE, the Cochrane Controlled Trial Register, Web of Science and Google Scholar databases to identify all randomized controlled trials (RCT) which compare the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary endpoints were opioid consumption during the postoperative 24 hours. Also collected were the pain scores at three different postoperative periods: early (0-6 h), middle (6-18 h), and late (18-24 h) period.
Results
Twenty-one RCT with a total of 1391 patients were included. TPVB showed a greatest effect on opioid consumption compared with control (mean difference (MD) = - 13.2 mg, 95% CI -16.2 to -10.1). In respect of the pain score in the early period, ESPB had the greatest effect compared with control (MD = -1.6, 95% CI -2.3 to -0.9). In the middle and late period, TPVB, ESPB and INB showed superior analgesic effect than control on pain score, but SPB did not.
Conclusions
TPVB showed most superior analgesic efficacy following VATS. ESPB provides a comparable analgesic efficacy with TPVB. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control for VATS.
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