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Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

dc.contributor.author Law, LS-C
dc.contributor.author Tan, M
dc.contributor.author Bai, Y
dc.contributor.author Miller, Timothy Ellis
dc.contributor.author Li, Y-J
dc.contributor.author Gan, Tong Joo
dc.coverage.spatial United States
dc.date.accessioned 2017-04-06T19:47:38Z
dc.date.available 2017-04-06T19:47:38Z
dc.date.issued 2015-08
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26086619
dc.identifier.uri http://hdl.handle.net/10161/13954
dc.description.abstract BACKGROUND: Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB for inguinal herniorrhaphy. Our study compares PVB with general anesthesia/systemic analgesia, neuraxial blocks, and other peripheral nerve blocks. METHODS: We analyzed 14 randomized controlled trials from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL up to February 2015, without language restriction, comparing PVB under sedation with general anesthesia/systematic analgesia (135 vs 133 patients), neuraxial blocks (191 vs 186 patients), and other peripheral nerve blocks (119 vs 117 patients). We investigated pain scores, consumption of postoperative analgesia, incidence of postoperative nausea and vomiting (PONV), length of hospital stay, postanesthesia care unit bypassing rate, time to perform blocks, intraoperative hemodynamics, and incidence of urinary retention. Joint hypothesis testing was adopted for pain and analgesics, PONV, and hemodynamic variables. All analyses were performed with RevMan 5.2.11 (Cochrane Collaboration, Copenhagen). Hartung-Knapp-Sidik-Jonkman method was used for post hoc testing. RESULTS: PVB reduced PONV (nausea: risk ratio [RR] = 0.22; 95% confidence interval [CI], 0.05-0.93; numbers needed to treat [NNT] = 4.5; I = 15% and vomiting: RR = 0.15; 95% CI, 0.03-0.76; NNT = 8.3; I = 0%) compared with general anesthesia/systematic analgesia (quality of evidence [QoE]: high). Compared with neuraxial blocks, PVB resulted in less postoperative nausea (RR = 0.34 [95% CI, 0.13-0.91], NNT = 8.3, I = 0%) and urinary retention (RR = 0.14 [95% CI, 0.05-0.42], NNT = 7.4, I = 0%) than neuraxial blocks (QoE: high). More time was needed to perform PVB than neuraxial blocks (standardized mean difference = 1.90 [95% CI, 0.02-3.77], I = 92%; mean difference = 5.33 minutes; QoE: moderate). However, the available data could not reject the null hypothesis of noninferiority on all pain scores and analgesic requirements for both PVB versus general anesthesia/systematic analgesia and PVB versus neuraxial blocks (QoE: low), as well as on hemodynamic outcomes for PVB versus neuraxial blocks (QoE: moderate). Our systematic review showed that PVB decreased postoperative pain scores and analgesic requirement as compared with ilioinguinal block and transversus abdominis plane block. CONCLUSIONS: This meta-analysis shows that PVB provides an anesthesia with fewer undesirable effects for inguinal herniorrhaphy. The choice between general anesthesia/systematic analgesia, neuraxial blocks, PVB, and other peripheral nerve blocks should be based on time available to perform the block and a complete coverage over the relevant structures by the blocks.
dc.language eng
dc.relation.ispartof Anesth Analg
dc.relation.isversionof 10.1213/ANE.0000000000000835
dc.subject Analgesics
dc.subject Chi-Square Distribution
dc.subject Hernia, Inguinal
dc.subject Herniorrhaphy
dc.subject Humans
dc.subject Length of Stay
dc.subject Nerve Block
dc.subject Odds Ratio
dc.subject Pain Measurement
dc.subject Pain, Postoperative
dc.subject Patient Selection
dc.subject Postoperative Nausea and Vomiting
dc.subject Randomized Controlled Trials as Topic
dc.subject Risk Factors
dc.subject Time Factors
dc.subject Treatment Outcome
dc.title Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26086619
pubs.begin-page 556
pubs.end-page 569
pubs.issue 2
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, General, Vascular, High Risk Transplant & Critical Care
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Molecular Physiology Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 121
dc.identifier.eissn 1526-7598


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