Systematic review and meta-analysis of the efficacy of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery

Juan Liao; Meiting Li; Jiaqi Gan; Jie Xiao; Guilin Xiang; Xizhi Ding; Rong Jiang; Peng Li

doi:10.21037/gs-21-719

Systematic review and meta-analysis of the efficacy of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery

Gland Surg. 2021 Nov;10(11):3106-3115. doi: 10.21037/gs-21-719.

Authors

Juan Liao^#¹, Meiting Li^#², Jiaqi Gan^#^{3

4}, Jie Xiao^{2

4}, Guilin Xiang^{2

4}, Xizhi Ding², Rong Jiang², Peng Li²

Affiliations

¹ Department of Stomatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
³ Department of Anesthesiology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.
⁴ Chengdu Medical College, Chengdu, China.

^# Contributed equally.

Abstract

Background: Breast cancer is a malignant tumor disease that poses a significant threat to women's health. In recent years, the incidence of breast cancer in China has been increasing. This report aims to explore the effects of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery.

Methods: A computer-based search of PubMed, Web of Science, Embase, and the Cochrane Library was performed to identify randomized controlled studies on breast cancer, general anesthesia combined with a thoracic nerve block, modified breast cancer surgery, and other breast cancer treatments. Further search criteria included postoperative pain score, postoperative morphine equivalents given 24 hours after surgery, and operation duration. After an initial selection process, the studies were evaluated using the Jadad scale and the Cochrane Handbook for Systematic Reviews of Interventions to assess their suitability for inclusion in the subsequent meta-analysis of the experimental data, which was carried out using RevMan 5.3.

Results: A total of 8 studies comprising a total of 624 patients were selected for inclusion in this report. According to the meta-analysis, the analytical structure of the thoracic nerve group and the control group had a mean difference (MD) of -1.27 [95% confidence interval (CI): -1.68 to -0.86], the structure of the statistical test was Z=6.08 (P<0.00001), the MD of the total analysis structure of morphine equivalents was -2.71 (95% CI: -4.98 to -0.44), and the statistical test structure was Z=2.34 (P=0.02).

Discussion: General anesthesia combined with a thoracic nerve block in breast cancer surgery may effectively improve postoperative pain in patients and reduce the need for analgesic drugs. However, the outcome indicators included in this study are not sufficient. It is necessary to increase both the sample size and the number of outcome indicators to provide further theoretical evidence for the subsequent application of thoracic nerve block in modified breast cancer surgery.

Keywords: General anesthesia; complex thoracic nerve block; modified breast cancer surgery; postmastectomy pain syndrome (PMPS).