Bayesian Network Meta-Analysis of Postoperative Analgesic Techniques in Thoracoscopic Lung Resection Patients.

Summary

Across randomized trials, paravertebral block (PVB) ranked best for 24-hour resting and coughing pain, while erector spinae plane block (ESPB) offered favorable safety; thoracic epidural anesthesia (TEA) showed strong early analgesia but was less suitable overall due to side effects. Consistency checks were acceptable, and rankings were robust to meta-regression and sensitivity analyses.

Key Findings

• SUCRA rankings: at 24 h, PVB > TEA > ESPB > INB > control > SAPB for resting/coughing VAS; at 12 h, TEA led early for resting and coughing pain.
• PVB consistently ranked highest for 24-hour resting and coughing VAS scores.
• ESPB identified as suitable with fewer side effects; TEA less suitable overall due to excessive side effects.
• Network consistency was acceptable with minimal publication bias; meta-regression showed study quality and incision infiltration did not significantly affect outcomes.

Clinical Implications

Prefer PVB for superior 24-hour analgesia after VATS lung resection; consider ESPB when safety and fewer side effects are priorities; limit routine TEA use due to adverse effects while individualizing based on patient risk.

Limitations

• Heterogeneity in block techniques, dosing, and perioperative protocols across trials
• Adverse event profiles and long-term functional outcomes were not fully delineated

Future Directions

Head-to-head pragmatic RCTs comparing PVB vs ESPB with standardized outcomes, safety endpoints, and resource use; integration into ERAS pathways for thoracic surgery.