Efficacy of paravertebral block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) often occur after anesthesia and may cause dissatisfaction among patients. Occasionally, PONV may result in complications after surgery. Steering clear of PONV stands as a crucial and pertinent objective in anesthesia. The use of paravertebral block (PVB) offers potent pain relief in surgical interventions. Nonetheless, the evidence is inadequate to prove its benefits in treating nausea and vomiting. This meta-analysis aimed to calculate the impact of PVB on PONV. METHODS: A pair of autonomous investigators carried out investigations for randomized controlled trials (RCTs) across Embase, PubMed, and the Cochrane Central Register of Controlled Trials.We used Review Manager software for the meta-analysis. RESULTS: Twenty-three trials with 2955 patients were included in this meta-analysis. The results showed that PVB reduced postoperative nausea (risk difference (RD) = -0.18, 95% confidence interval (CI): -0.24 to -0.13) compared with no PVB. Compared to no PVB approaches, PVB significantly reduced opioid consumption, as evidenced by standardized mean difference (SMD) of -0.87 (95% CI: -1.63 to -0.11) for fentanyl, -1.48 (95% CI: -1.90 to -1.06) for sufentanil, and − 1.47 (95% CI: -2.27 to -0.68) for morphine. PVB could reduce the VAS rest at 0–2 h (SMD = -2.78, 95% CI: -4.20 to -1.36), at 4–6 h (SMD = -1.31, 95% CI: -1.90 to -0.72) and 24 h (SMD = -0.84, 95% CI: -1.16 to -0.52), shortened hospitalization (SMD = -0.74, 95% CI: -1.32 to -0.17), prolonged time to rescue analgesia (SMD = 5.79, 95% CI: 2.42 to 9.16) and reduced the incidence of pruritus (SMD = -0.05, 95% CI: -0.09 to -0.02). GRADE showed this meta-analysis to have moderate or low or very low confidence. Trial sequential analysis for mortality indicated sufficient sample size for a definitive judgment for lower incidence of nausea and vomiting . CONCLUSION: This meta-analysis indicates that PVB could lower PONV occurrences.and its effectiveness might be affected by variables like the amount of local anesthetic used, and its concentration.