PMID- 34164315
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 2227-684X (Print)
IS  - 2227-8575 (Electronic)
IS  - 2227-684X (Linking)
VI  - 10
IP  - 5
DP  - 2021 May
TI  - A systematic review and meta-analysis of the effects of general anesthesia 
      combined with continuous paravertebral block in breast cancer surgery and 
      postoperative analgesia.
PG  - 1713-1725
LID - 10.21037/gs-21-272 [doi]
AB  - BACKGROUND: This study aimed to compare the effects of general anesthesia (GA) 
      combined with continuous paravertebral block (CPVB) in breast cancer surgery via 
      systematic review and meta-analysis, in order to provide a theoretical basis for 
      the clinical use of CPVB surgical analgesia. METHODS: A search of the PubMed, 
      Embase, Medline, Ovid, Springer, and Web of Science databases was conducted to 
      screen clinical trials on GA + CPVB for breast cancer surgery published before 
      December 31, 2020. The Cochrane Handbook for Systematic Reviews of Intervention 
      5.0.2 was adopted for bias risk assessment, and Review Manager 5.3 software 
      (RevMan, The Cochrane Collaboration, http://tech.cochrane.org/revman) was applied 
      for meta-analysis of the literature. RESULTS: A total of 15 studies that 
      satisfied the requirements were included, involving a total of 1,435 research 
      subjects. The results of our meta-analysis showed the following: the visual 
      analogue scale (VAS) score of the observation group (group A) was significantly 
      reduced [mean difference (MD) =-0.68; 95% confidential interval (CI): -1.04 - 
      -0.33; Z=3.80; P=0.0001]; the level of monocyte chemoattractant protein -1 
      (MCP-1) was notably decreased (MD =-18.64; 95% CI: -29.68 - -7.61; Z=3.31; 
      P=0.0009); the level of tumor necrosis factor-alpha (TNF-alpha) was markedly lower (MD 
      =-1.89; 95% CI: -2.66 - -1.13; Z=4.87; P<0.00001); the interleukin-6 (IL-6) level 
      was obviously reduced (MD =-12.10; 95% CI: -19.22 - -4.99; Z=3.33; P=0.0009); and 
      the incidence of postoperative adverse reactions was substantially decreased (MD 
      = 0.16; 95% CI: 0.07-0.36; Z=4.47; P<0.00001). Compared with group B, the 
      differences of the above five indicators showed statistical significance. In 
      addition, the heart rate (HR) (MD =-1.56; 95% CI: -6.20 - 3.08; Z=0.66; P=0.51), 
      mean arterial pressure (MAP) (MD = 4.66; 95% CI: -0.12 -9.43; Z=1.91; P=0.06), 
      Ramsay score (MD =0.44; 95% CI: -0.06-0.93; Z=1.73; P=0.08) of patients in group 
      A showed no statistical differences compared to group B. CONCLUSIONS: GA + CPVB 
      applied to breast cancer surgery for analgesia can reduce the levels of MCP-1, 
      TNF-alpha, and IL-6 in patients, thereby providing good postoperative analgesia. 
      Therefore, GA + CPVB could effectively reduce the incidence of pain and adverse 
      reactions in patients, and is effective for analgesia in breast cancer surgery.
CI  - 2021 Gland Surgery. All rights reserved.
FAU - Feng, Changsheng
AU  - Feng C
AD  - Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical 
      College, Nanchong, China.
FAU - Qian, Duo
AU  - Qian D
AD  - Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical 
      College, Nanchong, China.
FAU - Chen, Changlin
AU  - Chen C
AD  - Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical 
      College, Nanchong, China.
LA  - eng
PT  - Journal Article
PL  - China (Republic : 1949- )
TA  - Gland Surg
JT  - Gland surgery
JID - 101606638
PMC - PMC8184377
OTO - NOTNLM
OT  - General anesthesia combined with continuous paravertebral block (GA combined with 
      CPVB)
OT  - analgesia
OT  - breast cancer surgery
OT  - meta-analysis
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at http://dx.doi.org/10.21037/gs-21-272). The authors have no 
      conflicts of interest to declare.
EDAT- 2021/06/25 06:00
MHDA- 2021/06/25 06:01
PMCR- 2021/05/01
CRDT- 2021/06/24 06:38
PHST- 2021/06/24 06:38 [entrez]
PHST- 2021/06/25 06:00 [pubmed]
PHST- 2021/06/25 06:01 [medline]
PHST- 2021/05/01 00:00 [pmc-release]
AID - gs-10-05-1713 [pii]
AID - 10.21037/gs-21-272 [doi]
PST - ppublish
SO  - Gland Surg. 2021 May;10(5):1713-1725. doi: 10.21037/gs-21-272.