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The following is a summary of “Bayesian Network Meta-Analysis of Postoperative Analgesic Techniques in Thoracoscopic Lung Resection Patients,” published in the February 2025 issue of Pain and Therapy by Yue et al. 

Postoperative analgesia was crucial in thoracoscopic lung resection, with various nerve block techniques commonly used amid ongoing debate about the optimal approach.  

Researchers conducted a retrospective study to compare the efficacy of different nerve block techniques for postoperative analgesia in thoracoscopic lung resection.  

They searched multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to identify relevant randomized clinical trials (RCTs). A Bayesian network meta-analysis was performed to evaluate postoperative pain management. Subgroup analyses and meta-regression were carried out to explore key factors affecting outcomes, such as the risk of bias, continuous catheter analgesia, and patient-controlled analgesia (PCA).  

The results showed that for 12-hour resting visual analog scale (VAS) scores, the surface under the cumulative ranking curve (SUCRA) ranking was thoracic epidural anesthesia (TEA) > paravertebral block (PVB) > erector spinae plane block (ESPB) > control > intercostal nerve block (INB) > serratus anterior plane block (SAPB). At 24 hours, the ranking changed to PVB > TEA > ESPB > INB > control > SAPB. For 12-hour coughing VAS scores, TEA ranked highest, followed by PVB, SAPB, ESPB, and control, while at 24 hours, PVB ranked highest, followed by TEA, ESPB, SAPB, INB, and control. The inconsistency test confirmed good consistency with minimal publication bias. Meta-regression showed no significant impact of study quality or local anesthetic infiltration at the incision site on outcomes. The SUCRA rankings remained unchanged after excluding studies without PCA while, PVB consistently ranked highest for 24-hour resting and coughing VAS scores, and clustered ranking plots identified PVB and ESPB as the most effective techniques for postoperative analgesia.  

Investigators concluded that PVB provided superior pain relief, while ESPB offered a safer alternative with fewer adverse effects for thoracoscopic lung resection.

Source: link.springer.com/article/10.1007/s40122-025-00712-y