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Pre-Operative Selective vs Non-Selective α-Blockade in Pheochromocytoma-Paraganglioma Patients Undergoing Surgery: A
Sanjay K Yadav1, Goonj Johri2, Chandan K Jha3
1Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Indian Journal of Endocrinology and Metabolism
|June 6, 2022
Summary
This systematic review found no significant difference in intra-operative outcomes between selective alpha blockade (SAB) and non-selective alpha blockade (NSAB) for pheochromocytoma surgery. However, non-selective blockade may offer a hemodynamic advantage, though clinical benefits require further study.
Area of Science:
- Pharmacology and Surgical Anesthesia
- Endocrinology and Oncology
Background:
- Pheochromocytomas and paragangliomas (PPGL) surgery requires careful hemodynamic management.
- Alpha blockade therapy is crucial for perioperative control, with selective (SAB) and non-selective (NSAB) agents being common choices.
- The comparative efficacy and safety of SAB versus NSAB in PPGL surgery remain incompletely understood.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing selective alpha blockade (SAB) versus non-selective alpha blockade (NSAB) in patients undergoing surgery for PPGL.
- To assess the effectiveness and safety profiles of SAB and NSAB therapies in this surgical context.
Main Methods:
- Systematic literature search of electronic databases.
- Meta-analysis of eligible studies using RevMan 5.3 software.
- Inclusion of eight articles, with only one randomized controlled trial identified.
Main Results:
- No significant difference was observed between SAB and NSAB groups regarding intra-operative systolic blood pressure >160 mm Hg (RR 0.95 [95% CI 0.57, 1.56], P=0.83) or intra-operative vasopressor requirement (RR 1.10 [95% CI 0.96, 1.26], P=0.16).
- A significant difference was found in post-operative vasopressor requirement, favoring NSAB (RR 1.66 [95% CI 1.0, 2.74], P=0.05).
- No significant difference was noted in post-operative complications between the groups (RR 0.84 [95% CI 0.58, 1.22], P=0.36).
Conclusions:
- Non-selective alpha blockade (NSAB) may offer a hemodynamic advantage over selective alpha blockade (SAB) due to potentially lower intra-operative vasodilator requirements.
- The observed difference in post-operative vasopressor needs did not translate into a significant advantage for NSAB concerning morbidity or mortality.
- Further high-quality studies are needed to definitively ascertain the clinical benefit of NSAB over SAB in PPGL surgery.
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