Efficacy of nerve blocks for postoperative analgesia in lung cancer: A meta‑analysis of randomized clinical trials

The management of postoperative pain in patients with lung cancer is a key factor affecting patient comfort and postoperative recovery. The aim of the present review was to compare regional block techniques with traditional analgesic methods, demonstrating their advantages in postoperative analgesia and facilitating patient recovery following thoracoscopic surgery. The effects of different regional analgesic techniques were systematically searched from establishment of the database to April 2024 in Web of Science, Embase and Cochrane. The search strategies were developed using the population, interventions, comparators, outcomes and study design framework, and the results are presented in accordance with the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses statement. The primary outcome was the visual analogue scale (VAS) score, with secondary outcomes including patient self-administered intravenous analgesia, number of patients requiring additional injections of analgesic following surgery and the incidence of adverse reactions as outcome indicators. The present meta-analysis included 14 randomized clinical trials with a total of 1,524 patients and four regional block techniques (paravertebral block, thoracic paravertebral block, serratus anterior plane block, intercostal nerve block). Based on limited evidence, regional block surgery was more effective at relieving postoperative pain and had a lower incidence of adverse reactions, but there was no significant difference in VAS scores between this group and the control group. Compared with the control group, five studies reported a significant decrease in the number of patients requiring additional painkillers following surgery in the group receiving nerve block (I²=14.9%). A total of seven studies showed a significant improvement in the use of patient-controlled analgesia (I²=72.5%); seven studies showed a decrease in nausea and vomiting (I²=22.1%) and four studies reported significant improvement in lung function (I²=44.8%). Other adverse reactions included delirium, drowsiness, venous thrombosis and intestinal obstruction. The present results indicated a significant decrease in various other adverse side effects in the experimental group (I²=46.4%), and there was no notable publication bias. Compared with conventional anesthesia, nerve block techniques in pain management following thoracoscopic surgery for lung cancer decreased the patient-controlled analgesia usage and the number of patients requiring additional postoperative analgesic, but the VAS scores remained inconsistent. In addition, nerve block technology had a lower incidence of postoperative complications and improved the quality of life of patients with cancer.