Ren Pusheng, Du Yu, He Guangquan, Jiang Dan
Department of Anesthesiology, Nanchong Central Hospital Affiliated North Sichuan Medical College, Nanchong, China.
Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
J Thorac Dis. 2022 Feb;14(2):431-442. doi: 10.21037/jtd-22-103.
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.
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.
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].
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.
胸段硬膜外阻滞（TEB）和椎旁阻滞（PVB）的镇痛效果、应激反应及肺功能的研究结果并不一致。本研究对相关文献进行荟萃分析，旨在比较两种镇痛方法的临床疗效和安全性，为临床镇痛方法的选择提供科学的循证依据。
检索PubMed、Embase、MEDLINE、Science Direct、Cochrane图书馆、中国知网、中国生物医学文献数据库、万方数据库、维普数据库及外文医学期刊全文服务系统。检索词如下：胸段硬膜外阻滞（TEB）、椎旁阻滞（PVB）、椎旁置管、开胸手术、镇痛。两名专业人员独立筛选文献并提取数据，采用Cochrane系统评价员手册（5.1.0版）对纳入研究的文献偏倚风险进行反复评估。
共纳入9篇文章。本研究的9项随机对照试验中，5项详细描述了分配隐藏，9项描述了正确的随机分配方法，1项未采用盲法。PVB组和TEB组在24小时和48小时的视觉模拟评分无统计学意义[平均差（MD）：-0.17，95%置信区间（CI）：-0.43至0.08，P=0.18；MD：0.21，95%CI：-0.06至0.48，P=0.13]。采用固定效应模型分析低血压、恶心、呕吐及尿潴留的发生率。结果显示，PVB组和TEB组之间存在显著差异[低血压：相对危险度（RR）：0.16，95%CI：0.06-0.46，P=0.0006；恶心：RR：0.40，95%CI：0.25-0.66，P=0.0002；呕吐：RR：0.23，95%CI：0.06-0.87，P=0.03；尿潴留：RR：0.36，95%CI：0.15-0.87，P=0.02]。
荟萃分析证实，在开胸肺手术中，PVB与硬膜外阻滞具有相同的镇痛效果和术后肺功能。此外，PVB可降低镇痛相关并发症及术后慢性疼痛的发生率。
