Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study

Abstract

Background: Erector spinae plane block could be a potential alternative to paravertebral block or other analgesic techniques for breast surgery, but the current evidence on erector spinae plane block in breast surgery is conflicting. Objective: To compare the analgesic effectiveness between erector spinae plane block, systemic analgesic, and paravertebral block for breast surgery. Study Design: Meta-analysis. Setting: The literature search was performed from 2016 to August 2020 using the MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases. Methods: Clinical trials comparing erector spinae plane block to systemic analgesic and paravertebral block were included from the aforementioned databases. Primary outcomes were 24-hour postoperative opioid administration and postoperative pain score. Secondary outcomes were patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related side effects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysis were performed according to the PRISMA statement. Results: We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemic analgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperative intravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Compared with paravertebral block, no statistical difference was found in opioid administration. No differences were observed in pain score, opioid-related side effects, or analgesic technique-related complications. Between the trials, heterogeneity existed and could not be evaluated using metaregression owing to inadequate reported data. Limitations: Moderate heterogeneity among the included trials could not be assessed by potential covariates owing to the limited reported data in each trial. Conclusion: Erector spinae plane block is superior to systemic analgesic within 24 hours after breast surgery and can serve as an alternative to paravertebral block with similar analgesic effects. Key words: Erector spinae plane block, paravertebral block, breast surgery, perioperative analgesia, randomized controlled trial, meta-analysis

A Randomized Clinical Study to Compare the Perioperative Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block Over Thoracic Epidural in Modified Radical Mastectomy

“…In a randomized trial, Eskandr et al discovered that erector spinae block exhibited comparability to paravertebral block in terms of analgesia and morphine consumption, but the latter was linked to an incident of pneumothorax [ 21 ]. A meta-analysis by Weng et al determined that erector spinae block surpassed systemic analgesia while maintaining comparability to paravertebral block [ 22 ]. A recent systematic review conducted by Guan et al affirmed that erector spinae block led to notably reduced opioid consumption, decreased postoperative pain intensity, and fewer nerve-related complications [ 23 ].…”

Relative efficacy and safety of several regional analgesic techniques following thoracic surgery: a network meta-analysis of randomized controlled trials

“…Additionally, ESPB ranked highest in hospitalization durations, postoperative complications, total adverse events, and PONV. Furthermore, two meta-analyses 43 , 44 suggested that the analgesic effect of ESPB was comparable to TEA and may not be inferior to TPVB.…”