Clinical Study Of Pectoral Nerve Block Ⅱ Technique In Perioperative Analgesia Of Thoracic Surgery

Background: In recent years,Video-assisted Thoracoscopic Surgery（VATS）has been widely used in clinical treatment.Compared with traditional thoracotomy,although VATS has smaller incision and tissue damage,postoperative pain and pain-induced complications are still non-negligible problems.Ultrasound guided pectoral nerve block II（PECSII）is a novel regional block techniques of chest wall,which is widely used in the breast surgeries,but there are few reports in postoperative analgesia of VATS.Methods: Forty patients who underwent VATS in our hospital were selected and1:1randomly divided into two groups（PECSII group and placebo group）.Patients in the PECSII group received regional block before general anesthesia with 25 ml of0.5% ropivacaine,while patients in the placebo group received the same amount of0.9% normal saline.The primary endpoint was the total consumption of fentanyl,and the secondary endpoint included the Numerical Rating Scale（NRS）at each time interval after VATS,intraoperative hemodynamics,rescue analgesic time,and the incidence of adverse reactions.Results: Compared with the placebo group,the consumption of opioid within 24 hours in patient-controlled intravenous analgesia（PCIA）pump and total consumption of fentanyl were significantly lower in the PECSII group.The difference was statistically significant（P < 0.05）.The application rate of rescue analgesia in the PECSII group was significantly lower than that in placebo group（P < 0.05）in Postanesthesia care unit（PACU）.In addition,the NRS in the PECSII group was significantly lower than that of the placebo group at 1 and 4 hours after surgery,the difference was also statistically significant（P < 0.05）.In terms of hemodynamics,we found that mean arterial pressure（MAP）and Heartrate（HR）in the PECSII group were significantly lower than those in placebo group at chest entering（T1）（P < 0.05）.In addition,no significant adverse events were recorded.Conclusions: Pretreatment of PECS II can stabilize the intraoperative circulation,reduce the postoperative pain and consumption of opioids in VATS.However,the application of PECS II in multi-port VATS is still worth considering.The conclusion of this study needs to be supported by multi-center large sample studies.Background: Postoperative pain management in breast surgery and video-assisted thoracic surgeries（VATS）remains challenging.Oral or intravenous infusion of opioids were early treatments,but they can result in gastrointestinal reactions,respiratory inhibition,and other adverse reactions.In recent years,various regional block techniques have been employed in postoperative analgesia of surgeries.However,the pair-wise Meta-analysis can not comprehensively rank and evaluate the analgesic effects and adverse events of various regional blocks.The purpose of this network Meta-analysis（NMA）was to compare the analgesic effects and adverse events of different regional block techniques after breast surgery and VATS.Methods: Pubmed,Embase,and Cochrane Library were searched systematically for RCTs comparing analgesic effects and adverse events after breast surgery and VATS.After critical appraisal,a random-effects NMA was mainly used to compare all the regional blocks’ analgesic effects and adverse events.The Population,Interventions,Comparators,Outcomes,and Study design（PICOS）framework was used to build the search strategies and present the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA）statement guidelines.The primary endpoint was opioid consumption within 24 hours after the operation,and the secondary endpoints included dynamic and static pain scores and the incidence of nausea and vomiting.This study is registered in PROSPERO with a PROSPERO number of CRD42021283907.Results: A total of 21 clinical trials,including 1284 participants and 6 different regional block techniques（paravertebral block [PVB],pectoral nerve block [PECS],serratus anterior plane block [SAPB],intercostal nerve block [ICNB],erector spinal plane block [ESPB] and thoracic epidural anesthesia [TEA]）,were included and analyzed.There was no significant difference between the consistent and the inconsistent models（P > 0.05）.Based on limited evidence,we think that SAPB has certain advantages in relieving postoperative analgesia,while ICNB and PECS play a positive role in preventing postoperative nausea and vomiting.In this study,and we found no obvious publication bias.Conclusions: After a comprehensive evaluation of postoperative analgesic effects and adverse events based on the NMA,we hypothesize that SAPB and ICNB have distinct advantages in postoperative analgesia and reduce the incidence of nausea and vomiting,respectively.However,conclusions drawn from more randomized controlled trials（RCTs）may be more convincing.