The Effect of Regional Anesthesia on Pulmonary Complications after Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-Analysis
Abstract
Jake Belli, Grant Weiderman, Philopateer Messeha, John Paul Lemchak and Stefanie Vallancourt
Postoperative pulmonary complications (PPCs) are relatively uncommon following video-assisted thoracoscopic surgery (VATS), but their occurrence is associated with significant morbidity and mortality. One of the primary focuses of decreasing pulmonary complications is adequately controlling pain to facilitate effective ventilation and pulmonary hygiene. Regional anesthesia is commonly utilized in VATS to sufficiently control pain, but their effects on PPCs have widely conflicting results. This systematic review and meta-analysis aimed to analyze the relative risk of developing PPCs after receiving regional anesthesia and general anesthesia compared to general anesthesia alone. A total of ten studies and 1043 patients were included. There was a 68% relative risk reduction of developing pneumonia in patients who received regional anesthesia and general anesthesia compared to general anesthesia alone (RR = 0.32, 95% CI 0.22 to 0.45, p = 0.0008). There was no decreased risk of developing atelectasis (RR = 0.41, 95% CI 0.10 to 1.68, p = 0.14) or hypoxia (RR = 0.76, 95% CI = 0.32 to 1.81, p = 0.45) when given regional anesthesia. There was no statistically significant mean difference in length of stay (LOS) between the regional anesthesia and general anesthesia group compared to general anesthesia alone (MD = -0.79, 95% CI = -1.75 to 0.17, p = 0.09). The findings suggest that regional anesthesia may reduce the risk of developing postoperative pneumonia, but further high-quality studies are needed to confirm these findings.