1. 2024;27;375-385The Efficacy and Safety of the Rhomboid Intercostal Block for Postoperative Analgesia in Chest Surgery and Breast Surgery: A Systemic Review and Meta-Analysis
   Systematic Review
   Qi hong Shen, MD, Yue-zhong Lv, MD, Ya-fen Shi, MD, Lan Lai, MD, Yan-jun Chen, MD, and Qing-he Zhou, PhD.

BACKGROUND: Prior research has suggested that the rhomboid intercostal block (RIB) may contribute to postoperative analgesia after surgeries of the chest and breast

OBJECTIVE: To explore the effectiveness and safety of RIB for postoperative analgesia, as well as whether RIB is superior to other types of nerve blocks.

STUDY DESIGN: A systematic review and meta-analysis.

SETTING: Querying electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, was part of the process in searching for eligible clinical trials for this meta-analysis and systematic review.

METHODS: The Cochrane Collaboration’s tool for quality evaluation was utilized in assessing the bias risk in the selected randomized controlled trials (RCTs). meta-analysis was facilitated through the utilization of Review Manager 5.3. The determination of the evidence’s quality adhered to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS: After the inclusion and exclusion criteria were established, the incorporation of 8 RCTs, encompassing 714 patients, took place. During the first 24 hours after the operation, patients in the RIB group exhibited lower pain scores and less opioid consumption than did those in the no-block group. Furthermore, a decrease in the incidence of postoperative vomiting and nausea was noted in the RIB group. Nevertheless, when comparing outcomes, it was revealed that the RIB group and the other nerve block group did not differ significantly.

LIMITATIONS: No subgroup analysis to investigate the sources of heterogeneity was performed. The number of studies in this meta-analysis of RIB compared to those that focus on other types of nerve block is relatively small. The optimal concentrations and volumes of local anesthetics were not evaluated.

CONCLUSIONS: RIB may be a new option for pain relief after chest and breast surgery.

KEY WORDS: Rhomboid intercostal block, pain score, opioid consumption