Review Meta Analysis
Epidural anesthesia may reduce post-thoracotomy chronic pain (OR 0.33) and paravertebral block reduce that following breast ca surgery (OR 0.37).pearl
- M H Andreae and D A Andreae.
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
- Br J Anaesth. 2013 Nov 1;111(5):711-20.
BackgroundRegional anaesthesia may reduce the risk of persistent (chronic) pain after surgery, a frequent and debilitating condition. We compared regional anaesthesia vs conventional analgesia for the prevention of persistent postoperative pain (PPP).MethodsWe searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL from their inception to May 2012, limiting the results to randomized, controlled, clinical trials (RCTs), supplemented by a hand search in conference proceedings. We included RCTs comparing regional vs conventional analgesia with a pain outcome at 6 or 12 months. The two authors independently assessed methodological quality and extracted data. We report odds ratios (ORs) with 95% confidence intervals (CIs) as our summary statistic based on random-effects models. We grouped studies according to surgical interventions.ResultsWe identified 23 RCTs. We pooled data from 250 participants in three trials after thoracotomy with outcomes at 6 months. Data favoured epidural anaesthesia for the prevention of PPP with an OR of 0.33 (95% CI 0.20-0.56). We pooled two studies investigating paravertebral block for breast cancer surgery; pooled data of 89 participants with outcomes ≈ 6 months favoured paravertebral block with an OR of 0.37 (95% CI 0.14-0.94). Adverse effects were reported sparsely.ConclusionsEpidural anaesthesia and paravertebral block, respectively, may prevent PPP after thoracotomy and breast cancer surgery in about one out of every four to five patients treated. Small numbers, performance bias, attrition, and incomplete outcome data especially at 12 months weaken our conclusions.
Although this Cochrane review supports the belief that epidural and paravertebral blocks may reduce persistent-surgical pain after thoracotomy or breast cancer surgery respectively, the authors highlight the low total number of subjects (only 339 patients) in the five trials analysed. This is enough evidence to consider the PSP-benefits of regional anesthesia, but far from enough to be conclusive or change practice.
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