Thoracic Paravertebral Block Versus Intercostal Nerve Block For Postoperative Analgesia In Patients Undergoing Video-assisted Thoracic Surgeries:A Meta-analysis

Objective:The purpose of this study is to implement a systematic analysis of the existing randomized controlled trials and evaluate the actual effectiveness and safety of TPVB and INB for pain management after VAST.Methods:Systematically searching the Chinese and foreign databases including CNKI,VIP,Wan Fang,PubMed,EBSCO,EMBASE,Web of Science and the Cochrane Library for randomized controlled trials that comparing TPVB and INB for pain management in patients undergoing VAST.All of the data was collected and evaluated by two researchers.Rev Man 5.3 was made use of implementing the meta-analysis.Results:Fifteen randomized controlled trials with a total of 901 patients（TPVB group = 453,INB group = 448）were included.The results of Meta analysis showed as follows.（1）VAS scores at 2h,6h,12 h and 24 h postoperatively at rest or during activity displayed notable difference between the two groups（P<0.05）,VAS scores in TPVB group were superior to those in INB group.（2）Morphine consumption in the TPVB group at 48 h postoperatively was notably lower than that in the INB group,and the difference between two groups was notably significant（P<0.05）.（3）TPVB did not notably differ from INB about the incidence of postoperative nausea and vomiting（P>0.05）.（4）The number of effective PCIA compressions was notably less in the TPVB group than that in the INB group,and the difference between two groups was notably significant（P<0.05）.（5）Compared to the INB group,the TPVB group had shorter time on the operating time of nerve block,and the difference was notably significant（P<0.05）.（6）Regarding postoperative analgesic satisfaction scores,compared with the INB group,the TPVB group had higher analgesic satisfaction scores,and the difference was notably significant（P<0.05）.（7）With regarding to the incidence of hematoma at the puncture site,a complication associated with nerve block,the difference was not notably significant（P>0.05）.Conclusion:TPVB was superior to INB in postoperative pain control;TPVB also showed more advantageous than INB in terms of postoperative morphine consumption at 48 h,the number of effective postoperative PCIA compressions,postoperative satisfaction,and operation time.However,TPVB did not differ from INB in terms of postoperative nausea and vomiting and incidence of hematoma at the puncture site.