Comparison of the efficacy and safety of thoracic epidural and paravertebral block in postoperative analgesia after thoracic surgery: a meta-analysis of randomized trials

Objectives Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used methods for pain relief after open chest surgery. However, due to their different characteristics, there are still controversies regarding the analgesic effect and safety of these two methods after chest surgery. This report represents the latest meta-analysis on this topic. Methods We searched PubMed, Embase, and Cochrane Library and identified randomized controlled trials on the use of paravertebral block and thoracic epidural analgesia after thoracic surgery. Two researchers independently screened the identified studies. The efficacy and safety of the two different analgesic methods were compared and analyzed. A meta-analysis was conducted using RevMan 5.4 software. This study has been registered in PROSPERO (CRD420251208232). Results Thirty-five trials were included. Compared with paravertebral block (PVB), thoracic epidural analgesia (TEA) provided significantly lower pain scores at 24 h postoperatively (Resting: MD 0.41, P = 0.03; Movement: MD 0.40, P = 0.03). However, no significant differences were observed at 48 h. PVB was associated with a significantly lower risk of complications, including hypotension (OR 0.13, P < 0.00001), postoperative nausea and vomiting (OR 0.38, P = 0.0004), and urinary retention (OR 0.23, P < 0.0001). Pulmonary complication rates were comparable between groups (OR 0.61, P = 0.06). Conclusion While TEA demonstrated slightly superior resting and movement pain control at the 24-h, these differences were no longer significant by 48 h. Most notably, PVB was associated with a significantly lower risk of hypotension, postoperative nausea and vomiting, and urinary retention. Overall, PVB is a safer and equally effective alternative to TEA for thoracic surgery.