A Systematic Review of Randomized Trials Evaluating Regional Techniques for Postthoracotomy Analgesia

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No Canadian affiliation. An affiliation-only frame — the usual design — would never have seen this work. It is one of the works that make the case for inverting the frame.

Machine scores (provisional)

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Teacher spread

0.302 · how far apart the two teachers sit on this one work

Validation status

score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Abstract

In Brief BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the “gold standard” in this setting; however, evaluation of the evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. METHODS: In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy. Postoperative pain, analgesic use, and complications were analyzed. RESULTS: Continuous paravertebral block was as effective as thoracic epidural analgesia with local anesthetic (LA) but was associated with a reduced incidence of hypotension. Paravertebral block reduced the incidence of pulmonary complications compared with systemic analgesia, whereas thoracic epidural analgesia did not. Thoracic epidural analgesia was superior to intrathecal and intercostal techniques, although these were superior to systemic analgesia; interpleural analgesia was inadequate. CONCLUSIONS: Either thoracic epidural analgesia with LA plus opioid or continuous paravertebral block with LA can be recommended. Where these techniques are not possible, or are contraindicated, intrathecal opioid or intercostal nerve block are recommended despite insufficient duration of analgesia, which requires the use of supplementary systemic analgesia. Quantitative meta-analyses were limited by heterogeneity in study design, and subject numbers were small. Further well designed studies are required to investigate the optimum components of the epidural solution and to rigorously evaluate the risks/benefits of continuous infusion paravertebral and intercostal techniques compared with thoracic epidural analgesia. IMPLICATIONS: Evidence from a systematic review evaluating different regional analgesic techniques for management of post-thoracotomy pain shows that paravertebral block is as effective as thoracic epidural local anesthetic for analgesia, and is associated with fewer side effects, whereas other techniques provide inferior analgesia or require further study. Based on current evidence, thoracic epidural analgesia and paravertebral block are recommended as first choice treatments; intrathecal or intercostal analgesia are recommended if those techniques are not possible; interpleural analgesia is not recommended.

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The record

Venue

Anesthesia & Analgesia

Topic

Anesthesia and Pain Management

Field

Medicine

Canadian institutions

—

Funders

McGill University

Keywords

MedicineAnesthesiaThoracotomyAnalgesicLocal anestheticOpioidIntercostal nervesEpidural spaceRandomized controlled trialSurgeryNerve block

Has abstract in OpenAlex

yes

API

/api/v1/works/W2002193364