Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Tao Jiang; Xuan Mo; Ruonan Zhan; Yi Zhang; Yao Yu

doi:10.5114/wiitm.2023.124407

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Thoracic surgery

abstract:

Meta-analysis

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Tao Jiang

¹

,

Xuan Mo

¹

,

Ruonan Zhan

²

,

Yi Zhang

¹

,

Yao Yu

¹

Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
The First Affiliated Hospital of Anhui Medical University Gaoxin district, Hefei, Anhui Province, China

Videosurgery Miniinv 2023; 18 (1): 52–68

DOI: https://doi.org/10.5114/wiitm.2023.124407

Online publish date: 2023/01/23

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Introduction
Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and intercostal nerve block (ICNB) are alternative treatments.

Material and methods
Network meta-analysis based on Bayesian analyses was performed to obtain results for direct comparison, indirect comparison, and network comparison, and to make rankings based on probabilities. Covariates were adjusted to determine the effect of the covariates on results of this study.

Results
The study identified 61 randomized controlled trials (RCTs) (4468 patients). There were results of probability ranking for the first (“best” treatment): 24 h morphine consumption, TPVB > ESPB > ICNB > SAPB. Covariate adjustment allowed the four treatments to change somewhat in the likelihood of the best choice.

Conclusions
TPVB ranks best in our analysis. ESPB is a viable alternative. SAPB and ICNB seem to play a limited role in postoperative pain management.

keywords:

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Tao Jiang 1 , Xuan Mo 1 , Ruonan Zhan 2 , Yi Zhang 1 , Yao Yu 1

network meta-analysis, covariate adjustment, video-assisted thoracoscopic surgery, nerve block

Tao Jiang

¹

,

Xuan Mo

¹

,

Ruonan Zhan

²

,

Yi Zhang

¹

,

Yao Yu

¹