Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis

Abstract

BackgroundErector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.MethodsA systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.ResultsA total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.ConclusionsESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings.Systematic Review Registration:http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.

Fascial plane blocks in children—Scientifically supported or not?

“…A closer examination of one of the most recent meta-analyses by Duan et al, based on no less than 13 individual studies, shows inconclusive evidence for a clear-cut benefit from ESPB, even when exclusively compared to no block or placebo. 49 A very recent adult RCT further supports this, finding no or only a minimal effect of using ESPB in this context. 50 If it is not possible to show a clear-cut beneficial effect of ESPB, in a situation where the anatomical reasoning might explain the efficacy, one cannot help but question whether the hypothesized nerve-blocking effect of FPBs is clinically relevant.…”

“…A literature search reveals several adult meta‐analyses (also including teenagers and adolescents) regarding the effect of ESPB in the context of spine surgery. A closer examination of one of the most recent meta‐analyses by Duan et al, based on no less than 13 individual studies, shows inconclusive evidence for a clear‐cut benefit from ESPB, even when exclusively compared to no block or placebo 49 . A very recent adult RCT further supports this, finding no or only a minimal effect of using ESPB in this context 50 .…”

Efficacy and Safety of Erector Spinae Plane Block for Perioperative Pain Management in Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…On the one hand, a meta-analysis conducted by Xiao et al 44 demonstrated that the pain scores at rest and on movement at 48 hours were significantly lower than those in the control group. On the other hand, the meta-analysis performed by Duan et al 45 showed no significant difference in pain scores at rest and on movement at 48 hours between the ESPB and control group. In the present meta-analysis, although no significant differences were noted in pain scores at rest at 48 hours between the ESPB group and control group, the pooled effect was associated with significant heterogeneity.…”

Multimodal Analgesia for Complex Spine Surgeries

“…Of note, the authors of the meta-analysis cautioned that the quality of pooled findings was judged to be low to moderate. In addition, none of the pooled studies had used continuous ESPB for postoperative analgesia 49,50…”