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Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Publication ,  Journal Article
Law, LS-C; Tan, M; Bai, Y; Miller, TE; Li, Y-J; Gan, T-J
Published in: Anesth Analg
August 2015

BACKGROUND: Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB for inguinal herniorrhaphy. Our study compares PVB with general anesthesia/systemic analgesia, neuraxial blocks, and other peripheral nerve blocks. METHODS: We analyzed 14 randomized controlled trials from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL up to February 2015, without language restriction, comparing PVB under sedation with general anesthesia/systematic analgesia (135 vs 133 patients), neuraxial blocks (191 vs 186 patients), and other peripheral nerve blocks (119 vs 117 patients). We investigated pain scores, consumption of postoperative analgesia, incidence of postoperative nausea and vomiting (PONV), length of hospital stay, postanesthesia care unit bypassing rate, time to perform blocks, intraoperative hemodynamics, and incidence of urinary retention. Joint hypothesis testing was adopted for pain and analgesics, PONV, and hemodynamic variables. All analyses were performed with RevMan 5.2.11 (Cochrane Collaboration, Copenhagen). Hartung-Knapp-Sidik-Jonkman method was used for post hoc testing. RESULTS: PVB reduced PONV (nausea: risk ratio [RR] = 0.22; 95% confidence interval [CI], 0.05-0.93; numbers needed to treat [NNT] = 4.5; I = 15% and vomiting: RR = 0.15; 95% CI, 0.03-0.76; NNT = 8.3; I = 0%) compared with general anesthesia/systematic analgesia (quality of evidence [QoE]: high). Compared with neuraxial blocks, PVB resulted in less postoperative nausea (RR = 0.34 [95% CI, 0.13-0.91], NNT = 8.3, I = 0%) and urinary retention (RR = 0.14 [95% CI, 0.05-0.42], NNT = 7.4, I = 0%) than neuraxial blocks (QoE: high). More time was needed to perform PVB than neuraxial blocks (standardized mean difference = 1.90 [95% CI, 0.02-3.77], I = 92%; mean difference = 5.33 minutes; QoE: moderate). However, the available data could not reject the null hypothesis of noninferiority on all pain scores and analgesic requirements for both PVB versus general anesthesia/systematic analgesia and PVB versus neuraxial blocks (QoE: low), as well as on hemodynamic outcomes for PVB versus neuraxial blocks (QoE: moderate). Our systematic review showed that PVB decreased postoperative pain scores and analgesic requirement as compared with ilioinguinal block and transversus abdominis plane block. CONCLUSIONS: This meta-analysis shows that PVB provides an anesthesia with fewer undesirable effects for inguinal herniorrhaphy. The choice between general anesthesia/systematic analgesia, neuraxial blocks, PVB, and other peripheral nerve blocks should be based on time available to perform the block and a complete coverage over the relevant structures by the blocks.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 2015

Volume

121

Issue

2

Start / End Page

556 / 569

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Postoperative Nausea and Vomiting
  • Patient Selection
  • Pain, Postoperative
  • Pain Measurement
  • Odds Ratio
  • Nerve Block
 

Citation

APA
Chicago
ICMJE
MLA
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Law, L.-C., Tan, M., Bai, Y., Miller, T. E., Li, Y.-J., & Gan, T.-J. (2015). Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg, 121(2), 556–569. https://doi.org/10.1213/ANE.0000000000000835
Law, Lawrence Siu-Chun, Mingjuan Tan, Yaowu Bai, Timothy E. Miller, Yi-Ju Li, and Tong-Joo Gan. “Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Anesth Analg 121, no. 2 (August 2015): 556–69. https://doi.org/10.1213/ANE.0000000000000835.
Law LS-C, Tan M, Bai Y, Miller TE, Li Y-J, Gan T-J. Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg. 2015 Aug;121(2):556–69.
Law, Lawrence Siu-Chun, et al. “Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Anesth Analg, vol. 121, no. 2, Aug. 2015, pp. 556–69. Pubmed, doi:10.1213/ANE.0000000000000835.
Law LS-C, Tan M, Bai Y, Miller TE, Li Y-J, Gan T-J. Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg. 2015 Aug;121(2):556–569.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 2015

Volume

121

Issue

2

Start / End Page

556 / 569

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Postoperative Nausea and Vomiting
  • Patient Selection
  • Pain, Postoperative
  • Pain Measurement
  • Odds Ratio
  • Nerve Block