This article used meta-analysis and systematic evaluation methods to compare the analgesic effect and incidence of adverse reactions of ultrasound-guided posterior block (RLB) and paravertebral block (PVB) in patients undergoing thoracic surgery. Pub Med, Cochrane Library, EMBase, CNKI, Wanfang Database, Vip Database, and China Biomedical Full-text Database were searched from the establishment of the library to 2022-12-01, and randomized controlled trials (RCTs) on the analgesic effect of ultrasound-guided RLB and PVB in thoracic surgery were collected and compared. Among them, the patients in the control group used ultrasound-guided RLB composite general anesthesia, and the patients in the experimental group used ultrasound-guided PVB combined general anesthesia. The primary outcomes were 2h, 6h, 12h, 24h, and 48h postoperative resting state and motor state NRS scores; Secondary outcomes were the number of analgesia and the incidence of adverse effects such as nausea, vomiting, and dizziness after surgery. Data were meta-analysed using Rev Man 5.3 software. A total of 220 patients in 4 RCT studies were included, including 110 cases in the RLB block group and 110 cases in the PVB group. The results of meta-analysis showed that compared with the PVB group (control group), the NRS score in the RLB group (experimental group) at rest at 6(MD=0.45,95%CI 0.16~-0.75,P=0.003) hand 24 h (MD=0.26, 95%CI 0.05~0.47, P=0.01) and NRS at 24h (MD=0.25, 95%CI 0.02~-0.48, P=0.03) exercise were significantly increased. There were no significant differences in NRS scores of resting state at 2h (MD=0.32,95%CI -0.22~0.66,P=0.06), 12h (MD=0.17,95%CI -0.03~0.36,P=0.09) and 48h (MD=0.07,95%CI -0.09~0.24,P=0.37) after surgery, NRS scores of exercise status at 2h (MD=0.26,95%CI -0.68~0.17,P=0.24), 6h (MD=0.09,95%CI -0.22~0.40,P=0.57), 12h (MD=0.04,95%CI -0.25~0.32,P=0.80) and 48h (MD=0.04,95%CI 0.22~0.30,P=0.74) after surgery, the number of postoperative remedial analgesia (RR=1.12,95%CI 0.45~2.79,P=0.82), postoperative vomiting nausea (RR=0.64,95%CI 0.34~1.19,P=0.16),  dizziness (RR=0.61,95%CI 0.22~1.64,P=0.32) and other adverse reactions. The available clinical evidence shows that ultrasound-guided PVB is better than RLB in the early postoperative (24h) analgesia of thoracic surgery, and there is no significant difference between the two in the long-term (48h) analgesia after surgery, and the incidence of adverse reactions such as nausea, vomiting and dizziness does not increase compared with RLB.

Lei Ni, Huang Qingqing, Liu Jingzhen, Li Qin, Dai Xuemei, Gong Gu. Meta analysis of ultrasound-guided posterior and paravertebral block for postoperative analgesia and adverse reactions in thoracic surgery. International Journal of Frontiers in Medicine (2023), Vol. 5, Issue 8: 20-28. https://doi.org/10.25236/IJFM.2023.050802.

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