Regional analgesia techniques for video assisted thoracic surgery: a frequentist network meta-analysis

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.