The purpose of this article was to evaluate the effectiveness of ultrasound-guided rhomboid-intercostal-low anterior serratus plane block (RISS) with thoracic paravertebral nerve block (TPVB) for postoperative analgesia in adults undergoing thoracoscopic surgery. We searched Embase, PubMed, Cochrane Library, China Knowledge, Wanfang Data, and Wipro for literature up to January 2024, and included RISS and TPVB for postoperative analgesia in adult thoracoscopic surgery. A randomized controlled trial (RCT) of RISS versus TPVB for thoracoscopic lobectomy in adults was included, and RevMan 5.3 software was used to analyze and compare the primary outcome indicators (VAS scores at 1h, 2h, 4h, 8h, 12h, 24h, and 48h postoperatively) and secondary outcome indicators (time to the first postoperative PCIA, intraoperative remifentanil use, and the incidence of nausea and vomiting) between the two groups. vomiting occurrence). Four RCTs with 314 patients were included in the study.Compared with the control group (TVPB group), the resting state pain scores were significantly higher in the test group (RISS group) at 1h (MD=0.70, 95% CI 0.48-0.92, P<0.00001), 2h (MD=0.14, 95% CI -0.06-0.22, P=0.0009), 12h (MD=0.33, 95% CI 0.19-0.47, P< 0.00001) and 24h (MD=0.17, 95% CI 0.03 to 0.31, P=0.01) resting state pain scores were significantly higher. Compared with the control group (TVPB group), the test group (RISS group) had significantly higher postoperative 1 h (MD=0.80, 95% CI 0.60 to 1.01, P<0.00001), 12 h (MD=0.34, 95% CI 0.18 to 0.51, P<0.00001), and 24 h (MD=0.18, 95% CI 0.03 to 0.34, P= 0.02) motor state pain scores were significantly higher. Compared with the control group (TVPB group), the time to the first postoperative PCIA press (MD=-1.34, 95% CI -1.76 to -0.91, P<0.00001) was significantly earlier in the test group (RISS group). Intraoperative remifentanil use (MD=30.43, 95% CI 6.00 to 54.86, P=0.01) was significantly increased in the test group (RISS group) compared with the control group (TVPB group). There was no statistically significant difference in resting state pain scores between the two groups of patients at 4h (MD=0.01, 95% CI -0.11 to 0.13, P=0.86), 8h (MD=0.24, 95% CI -0.05 to 0.53, P=0.10), and 48h (MD=0.08, 95% CI -0.04 to 0.28, P=0.18) postoperatively. The differences in postoperative motor status pain scores between the two groups of patients at 2 h (MD=0.02, 95% CI -0.10 to 0.14, P=0.78), 4 h (MD=0.06, 95% CI -0.10 to 0.22, P=0.48), 8 h (MD=0.11, 95% CI -0.14 to 0.37, P=0.38), 48 h (MD=0.07, 95% CI - 0.03 to 0.18, P=0.17) The difference in motor status pain scores was not statistically significant. There was no statistically significant difference in the incidence of postoperative nausea and vomiting (RR=1.60, 95% CI 0.66 to 3.87, P=0.29) between the two groups. The results of this study suggest that RISS can provide similar postoperative analgesia as TPVB, but its operation is simple and quick. Therefore, RISS can be a new option for postoperative analgesia in adult thoracoscopic surgery.

Liu Dan, Liang Yu, Liu Yinghai. Meta-analysis of the effects of ultrasound-guided rhomboid-intercostal-low anterior serratus plane block and thoracic paravertebral nerve block for postoperative analgesia in adults undergoing thoracoscopic surgery. Academic Journal of Medicine & Health Sciences (2024), Vol. 5, Issue 4: 21-29. https://doi.org/10.25236/AJMHS.2024.050403.

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