REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicData Science in Anesthesiology and Intensive CareView all 14 articles
Comparison of the efficacy and safety of thoracic epidural and paravertebral block in postoperative analgesia after thoracic surgery: A meta-analysis of randomized trials
Provisionally accepted
- Weifang People's Hospital, Weifang, China
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Objective: 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 24h postoperatively (Resting: MD 0.41, P=0.03; Movement: MD 0.40, P=0.03). However, no significant differences were observed at 48h. 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-hour, these differences were no longer significant by 48 hours. 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.
Keywords: Meta - analysis, pain relief, Paravertebral block, Thoracic epidural analgesia, Thoracic Surgery
Received: 16 Nov 2025; Accepted: 23 Jan 2026.
Copyright: © 2026 Qi, Li, Zhou, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaodong Zhang
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