Table_1_v1_The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials.docx

BackgroundParavertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery.
MethodsPubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software.
ResultsA total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I2 = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups.
ConclusionThis study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.

椎旁阻滞（Paravertebral block, PVB）已被广泛应用于术后镇痛领域，尤其适用于胸外科及乳腺外科手术。然而，椎旁阻滞用于肾脏手术术后镇痛的有效性与安全性仍未明确。因此，本研究旨在探讨椎旁阻滞在肾脏手术患者中的术后镇痛效果与安全性。

本研究系统检索了截至2021年12月20日的PubMed、Web of Science、Embase及Cochrane Library数据库，搜集所有评估肾脏手术中椎旁阻滞术后镇痛效果的随机对照试验（randomized controlled trial, RCT）。采用RevMan 5.4及Stata/MP 14.0软件完成荟萃分析。

本荟萃分析共纳入16项随机对照试验，涉及907例患者。其中10项研究针对经皮肾镜取石术（percutaneous nephrolithotomy, PCNL）患者，6项研究针对其他肾脏手术（肾切除术或肾盂成形术）患者。与对照组（无阻滞、假阻滞或其他神经阻滞）相比，荟萃分析结果显示：椎旁阻滞可显著降低术后24小时阿片类药物消耗量（标准化均数差（Standardized Mean Difference, SMD）=-0.99，95%置信区间（Confidence Interval, CI）：-1.60~-0.38，P=0.001，I²=92%）；可降低肾脏手术后静息状态下24小时内各时间点及运动状态下1小时、4小时、24小时的疼痛评分；此外，椎旁阻滞可延长术后首次要求镇痛的时间（SMD=2.16，95%CI：0.94~3.39，P=0.005，I²=96%），并降低术后追加镇痛的发生率（优势比（Odds Ratio, OR）=0.14，95%CI：0.06~0.33，P<0.00001，I²=50%）。亚组分析显示，椎旁阻滞在经皮肾镜取石术患者中的术后镇痛效果更为显著，且使用布比卡因进行椎旁阻滞似乎可获得更优的镇痛效果。此外，椎旁阻滞组与对照组在术后恶心、呕吐及瘙痒的发生率上无显著差异。

本研究表明，椎旁阻滞可为肾脏手术患者，尤其是经皮肾镜取石术患者提供有效的术后镇痛。此外，椎旁阻滞是一种安全的镇痛方式，未出现与镇痛相关的显著并发症。