title: A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis.
abstract: OBJECTIVE
  The most recent systematic review and meta-analysis comparing the analgesic efficacy and side effects of paravertebral and epidural blockade for thoracotomy was published in 2006. Nine well-designed randomized trials with controversial results have been published since then. The present report constitutes an updated meta-analysis of this issue.
  
  
  BACKGROUND
  Thoracotomy is a major surgical procedure and is associated with severe postoperative pain. Epidural analgesia is the gold standard for post-thoracotomy pain management, but has its limitations and contraindications, and paravertebral blockade is increasingly popular. However, it has not been decided whether the analgesic effect of the two methods is comparable, or whether paravertebral blockade leads to a lower incidence of adverse side effects after thoracotomy.
  
  
  METHODS
  Two reviewers independently searched the databases PubMed, EMBASE, and the Cochrane Library (last performed on 1 February, 2013) for reports of studies comparing post-thoracotomy epidural analgesia and paravertebral blockade. The same individuals independently extracted data from the appropriate studies.
  
  
  RESULTS
  Eighteen trials involving 777 patients were included in the current analysis. There was no significant difference in pain scores between paravertebral blockade and epidural analgesia at 4-8, 24, 48 hours, and the rates of pulmonary complications and morphine usage during the first 24 hours were also similar. However, paravertebral blockade was better than epidural analgesia in reducing the incidence of urinary retention (p<0.0001), nausea and vomiting (p = 0.01), hypotension (p<0.00001), and rates of failed block were lower in the paravertebral blockade group (p = 0.01).
  
  
  CONCLUSIONS
  This meta-analysis showed that PVB can provide comparable pain relief to traditional EPI, and may have a better side-effect profile for pain relief after thoracic surgery. Further high-powered randomized trials are to need to determine whether PVB truly offers any advantages over EPI.
authors.affiliation: Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xibing
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Shuqing
authors.initials: S
authors.lastname: Jin
authors.affiliation: Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xiaoyin
authors.initials: X
authors.lastname: Niu
authors.affiliation: Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Shukun
authors.initials: S
authors.lastname: Fu
authors.affiliation: Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013907:Thoracostomy; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology