Paravertebral block and persistent postoperative pain after breast surgery: meta-analysis and trial sequential...

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Outcomes

Background:

• Persistent postsurgical pain (PPP) is a significant concern following breast surgery.
• Paravertebral block (PVB) is a regional anesthesia technique used to manage breast surgery pain.
• Previous meta-analyses suggested PVB efficacy in reducing chronic pain, necessitating further investigation.

Purpose of the Study:

• To evaluate the effect of paravertebral block on the prevalence of persistent postsurgical pain after breast surgery.
• To assess the statistical significance and evidence sufficiency for PVB's role in preventing long-term pain.

Main Methods:

• Systematic review and meta-analysis of seven randomized controlled trials (559 patients).
• Inclusion of outcome-assessor-blinded trials comparing PVB with no PVB after breast surgery.
• Application of conventional meta-analysis and trial sequential analysis (TSA) to assess evidence robustness.

Main Results:

• Conventional meta-analysis showed no statistically significant risk reduction for persistent pain at 3, 6, or 12 months post-surgery.
• Risk ratios (95% CI) for pain at 3, 6, and 12 months were 0.75 (0.48-1.15), 0.57 (0.29-1.72), and 0.42 (0.15-1.23), respectively.
• Trial sequential analysis indicated insufficient sample sizes (18.3%, 6.8%, 4.2% of required information size at 3, 6, 12 months) to confirm findings.

Conclusions:

• The current evidence is insufficient to conclude whether paravertebral block reduces persistent postsurgical pain after breast surgery.
• This study is the first to analyze 12-month postoperative pain data, highlighting the need for larger, robust trials.
• Findings contrast with earlier meta-analyses, emphasizing the importance of TSA in evaluating evidence quality.