Analgesic efficacy of PECS vs paravertebral blocks after radical mastectomy: A systematic review, meta-analysis and trial sequential analysis.
Analgesia
Peripheral nerve block
Postoperative pain
Radical mastectomy
Journal
Journal of clinical anesthesia
ISSN: 1873-4529
Titre abrégé: J Clin Anesth
Pays: United States
ID NLM: 8812166
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
10
09
2019
revised:
07
01
2020
accepted:
15
02
2020
pubmed:
1
3
2020
medline:
22
6
2021
entrez:
1
3
2020
Statut:
ppublish
Résumé
Due to conflicting results published in the literature regarding the analgesic superiority between the paravertebral block and the PECS block, the study objective is to determine which one should be the first line analgesic treatment after radical mastectomy. Systematic review, meta-analysis and trial sequential analysis. Operating room, postoperative recovery area and ward, up to 24 postoperative hours. Patients scheduled for radical mastectomy under general anaesthesia. We searched five electronic databases for randomized controlled trials comparing any PECS block with a paravertebral block. The primary outcome was rest pain score (0-10) at 2 postoperative hours, analyzed according to the combination with axillary dissection or not, to account for heterogeneity. Secondary outcomes included rest pain scores, cumulative intravenous morphine equivalents consumption and rate of postoperative nausea and vomiting at 24 postoperative hours. Eight trials including 388 patients were identified. Rest pain scores at 2 postoperative hours were decreased in the PECS block group, with a mean difference (95%CI) of -0.4 (-0.7 to -0.1), I There is low quality evidence that a PECS block provides marginal postoperative analgesic benefit after radical mastectomy at 2 postoperative hours only, when compared with a paravertebral block, and not beyond. Clinical trial number: PROSPERO - registration number: CRD42019131555.
Identifiants
pubmed: 32113076
pii: S0952-8180(19)31449-7
doi: 10.1016/j.jclinane.2020.109745
pii:
doi:
Substances chimiques
Analgesics
0
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
109745Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest EA has received grants from the Swiss Academy for Anaesthesia Research (SACAR), Lausanne, Switzerland (no grant numbers attributed) and from B. Braun Medical AG, Sempach, Switzerland (no grant numbers attributed) and from the Swiss National Science Foundation to support his clinical research. EA has also received an honorarium from B. Braun Melsungen AG, Melsungen, Germany. KE is an Editor of Anaesthesia. No interest declared by the other author.