Objective: This meta-analysis assesses the efficacy and safety of erector spinae block (ESPB) and paravertebral block (PVB) for managing postoperative pain in thoracic and breast surgeries.
Design: Data from 12 randomized controlled trials (RCTs) published between 2019 and 2022 were included, and selected based on stringent criteria.
Setting: The RCTs were conducted across various clinical settings, including operating theaters worldwide.
Patients: The analysis involved 844 patients undergoing thoracic or breast surgery under regional anesthesia, representing diverse health statuses.
Interventions: Patients received either PVB or ESPB, typically guided by ultrasound, for postoperative pain control.
Main findings: PVB demonstrated superior pain management during rest and mobility, requiring fewer additional analgesics than ESPB. Incidences of postoperative nausea and vomiting (PONV) and opioid consumption did not differ significantly between the methods. ESPB showed more effective block placement.
Conclusion: PVB is preferred for reducing analgesic requirements and managing postoperative pain, especially during rest and activity. ESPB offers advantages in block placement. Surgical type and patient preferences should guide the choice between PVB and ESPB, necessitating further research for optimized clinical application.
Keywords: Analgesia; Breast surgery; Erector spinae plane block (ESPB); Opioid consumption; Postoperative nausea and vomiting (PONV), Pain control; Postoperative pain management; Regional anesthesia techniques; Thoracic paravertebral block (TPVB); Thoracic surgery.
This study evaluated two pain management methods: paravertebral block (PVB) and erector spinae block (ESPB), utilized for chest and breast procedures. It intended to determine which method was more effective in lowering discomfort, the need for further pain medication, and the time required to conduct the block. The researchers studied 12 trials between 2019 and 2022, including 844 patients from various nations. Patients were given either a PVB or an ESPB, often performed using ultrasonography. The findings indicated that PVB was more effective at managing pain during rest and activity, reducing the need for further pain medication. There was no significant difference between the two techniques in terms of opioid use or postoperative nausea and vomiting. ESPB was faster to perform. To put it simply, PVB is indicated for better pain management following surgery, but ESPB is preferred for its rapid application. When deciding between the two, consider the type of surgery and the patient’s preferences. More research is needed to improve these pain-relief approaches.