The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials

You Zhao; Yanan Kan; Xin Huang; Ming Wu; Weiping Luo; Jun Nie

doi:10.3389/fsurg.2022.865362

The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials

Front Surg. 2022 Jul 18:9:865362. doi: 10.3389/fsurg.2022.865362. eCollection 2022.

Authors

You Zhao¹, Yanan Kan², Xin Huang¹, Ming Wu¹, Weiping Luo¹, Jun Nie¹

Affiliations

¹ Department of Urology, People's Hospital of Liyang City, Liyang, China.
² Department of Orthopedic, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.

Abstract

Background: Paravertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery.

Methods: PubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software.

Results: A total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = -0.99, 95%CI: -1.60-0.38, p = 0.001, I ² = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94-3.39, p = 0.005, I ² = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I ² = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups.

Conclusion: This study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.

Keywords: efficacy; opioid; pain scores; paravertebral block; postoperative analgesia; renal surgery; safety.

Publication types

Review