# Safety and Efficacy of Ultrasound-Guided Retrolaminar and Midpoint Transverse Process to Pleura Blocks Compared to Ultrasound-Guided Classic Paravertebral Block for Breast and Thoracic Surgery: A Systematic Review and Meta-Analysis

## TL;DR

This study compares new ultrasound-guided nerve blocks to a traditional one for pain relief in chest and breast surgeries, finding them equally effective but safer.

## Contribution

The study introduces and evaluates two novel ultrasound-guided blocks as safer alternatives to the classic paravertebral block.

## Key findings

- MTP block and RLB provide analgesic efficacy comparable to classic PVB.
- MTP block/RLB had higher pain scores with movement and more opioid use in 24 hours.
- Pneumothorax and pleural puncture occurred only in the PVB group.

## Abstract

The ultrasound-guided midpoint transverse process to pleura (MTP) block and retrolaminar block (RLB) have emerged as promising alternatives to the classic paravertebral block (PVB) for breast and thoracic surgery. This systematic review and meta-analysis of randomized controlled trials was conducted to compare the analgesic efficacy and safety of these newer techniques with the traditional PVB. Our pooled analysis revealed that MTP block and RLB offer early postoperative analgesic efficacy comparable to PVB. However, the MTP block/RLB group tended to have slightly higher pain scores with movement and greater cumulative opioid consumption in the first 24 hours. Regarding safety, all reported cases of pneumothorax or pleural puncture occurred exclusively in the PVB group. The enhanced safety profile and potentially simpler technique associated with the MTP block and RLB suggest that they may be valuable alternatives to the classic PVB in clinical practice.