title: Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: Systematic review.
abstract: OBJECTIVE
  Thoracotomy is a procedure associated with postoperative severe pain. Epidural block (EB) is considered the gold standard for its control. Paravertebral block (PVB) is an option for the management of postoperative pain. The aim of this study was to evaluate by meta-analyses the effectiveness of continuous thoracic epidural and paravertebral blocks for pain management after thoracotomy and the incidence of adverse effects.
  
  
  METHODS
  The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. We analyzed primary (postoperative pain at rest) and secondary outcomes (urinary retention, nausea, vomiting, hypotension). We estimated the weighted mean difference for continuous variables and odds ratios for categorical variables.
  
  
  RESULTS
  We included eight prospective, randomized, controlled studies. Meta-analysis showed no statistically significant differences between the two techniques regarding the outcomes of postoperative pain at rest at four, eight, 12, 16, 20, 24, 36, and 48 hours. Incidence of urinary retention was higher in EP group (OR = 7.19, CI95 = 1.87 to 27.7). The occurrence of hypotension was higher in PVB group (OR = 10.28, 95 = 2.95 to 35.77). There was no statistically significant difference between both groups regarding the outcome nausea/vomiting (OR = 3.00, CI95 = 0.49 to 18.45).
  
  
  CONCLUSIONS
  There were no statistically significant differences in pain relief after thoracotomy between EB and PVB. PVB showed a lower incidence of side effects with reduced frequency of urinary retention and hypotension.
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Alberto de Pontes Jardim
authors.initials: Ade P
authors.lastname: Júnior
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Thomas Rolf
authors.initials: TR
authors.lastname: Erdmann
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Thiago Viçoso dos
authors.initials: TV
authors.lastname: Santos
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Guilherme Muriano
authors.initials: GM
authors.lastname: Brunharo
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Clovis Tadeu Bevilacqua
authors.initials: CT
authors.lastname: Filho
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Márcio Joaquim
authors.initials: MJ
authors.lastname: Losso
authors.affiliation: Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia Integrado de Anestesiologia da Secretaria de Estado de Saúde de Santa Catarina, Florianópolis, SC, Brasil. Electronic address: oliveirafilho.gr@gmail.com.
authors.forename: Getúlio R de Oliveira
authors.initials: GR
authors.lastname: Filho
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D013908:Thoracotomy / Q000009:adverse effects*
keywords: Analgesia; Anesthesia; Epidural; Nerve Block; Pain; Postoperative; Postoperative Complications; Thoracotomy