Pectoral block versus paravertebral block: a systematic review, meta-analysis and trial sequential analysis

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Oncology

Background:

• Pectoral (PECs) block was introduced as a potentially safer alternative to thoracic epidural or paravertebral block (PVB) for breast surgery analgesia.
• This study systematically reviews and meta-analyzes the comparative analgesic efficacy and adverse events of PECs block versus PVB.

Purpose of the Study:

• To compare the perioperative analgesic efficacy of PECs block and PVB.
• To evaluate and compare the incidence of adverse events associated with both techniques.

Main Methods:

• A systematic literature search was conducted across multiple databases including PubMed, EMBASE, and CINAHL.
• Ten randomized controlled trials (RCTs) involving 502 patients were included in the meta-analysis.
• Analgesic efficacy was measured by time to first rescue analgesia and 24-hour opioid consumption; adverse events were descriptively reported.

Main Results:

• No significant difference was found in 24-hour opioid consumption between PECs block and PVB.
• The time to first rescue analgesia was also comparable between the two analgesic techniques.
• Postoperative nausea and vomiting was the most frequently reported adverse event, with no significant difference noted between groups.

Conclusions:

• PECs block and PVB demonstrate similar postoperative analgesic efficacy for mastectomy patients.
• Further research is unlikely to change the current understanding of opioid requirements for these techniques.
• The selection between PECs block and PVB should be guided by clinician proficiency and institutional protocols.