Opioid‐sparing effects of ultrasound‐guided erector spinae plane block for adult patients undergoing surgery: A systematic review and meta‐analysis

Abstract

Background Erector spinae plane block (ESPB) is a new method of administering analgesics to patients perioperatively. The aim of this meta‐analysis was to evaluate the opioid‐sparing effects of erector spinae plane block in patients during the perioperative period compared to conventional analgesia and identify its role in the development of opioid‐free anesthesia. Methods Relevant study articles were retrieved from PubMed, the Web of Science, Medline via Ovid, Embase via Ovid, and the Cochrane Central Register of Controlled Trials (CENTRAL) on June 11, 2020. We included randomized controlled trials (RCTs) comparing the use of ESPB with control (no/sham block). The primary outcome was opioid consumption at 24 h after surgery and intraoperative opioid consumption. A random‐effects model was used to calculate the standardized mean difference (SMD) and odds ratio (OR) with 95% confidence interval (CI) if there was significant heterogeneity in the data; otherwise, the fixed‐effect model was used. Results A total of 25 randomized controlled trials involving 1461 patients were included. The use of ultrasound‐guided ESPB was associated with reduced opioid consumption at 24 h after surgery [SMD: −2.14, 95% CI: −2.61 to −1.67, p < 0.001] and during the intraoperative period [SMD: −2.30, 95% CI: −3.21 to −1.40, p < 0.001]. In addition, it took a longer time to administer the first rescue analgesia in the ESPB group [SMD: 3.60, 95% CI: 2.23–4.97, p < 0.001] and the group was associated with lower incidences of postoperative nausea or vomiting (PONV) [OR: 0.50, 95% CI: 0.34–0.72, p < 0.001]. Conclusions Ultrasound‐guided ESPB could provide an opioid‐sparing effect and effective analgesia in adults undergoing surgeries with general anesthesia, and then promote opioid‐free anesthesia development.

Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials

“…In our updated analysis, ESPB reduced the pain score at postoperative 24 h. To our knowledge, this is the first meta-analysis to show the long-lasting analgesic effect of ESPB at 24 h in LC. Postoperative opioid consumption was also lower than that in the control group, which is consistent with the findings of previous studies [39][40][41]. Unexpectedly, no significant difference was noted in the intraoperative opioid consumption between the ESPB and control groups.…”

Erector spinae plane block for peri‐operative analgesia in a patient undergoing surgery for Ewing's sarcoma of the clavicle

“…Although the estimated incidence of haematoma after peripheral nerve blocks is between 0.67% and 0.82% [9], the clinically significant haemorrhagic complications are mainly attributed to deep, non‐compressible nerve blocks such as paravertebral, lumbar sympathetic, lumbar plexus blocks [10]. The ESP block provides analgesia for multiple dermatomes with haemodynamic stability [11]. So, considering the above‐mentioned advantages, we deemed that ESP block would be a better alternative to paravertebral or neuraxial block in this case.…”

“…In summary, the ESP block is a technically straightforward approach that can have an opioid‐sparing effect in the peri‐operative period with a lower risk of complications in an anticoagulated patient than central neuraxial blocks [8, 11, 12]. This case highlights the effective peri‐operative analgesia provided to the patient with the help of a relatively simple ESP block for a complicated and extensive clavicle surgery.…”

Ultrasound-guided erector spinae plane block improve opioid-sparing perioperative analgesia in pediatric patients undergoing thoracoscopic lung lesion resection: a prospective randomized controlled trial

“…In contrast, ultrasound-guided ESPB is a safer analgesic technique and is technically simpler than the above 2 modalities. Therefore, many authors have proposed that it could be used as a component of multimodal analgesia to accelerate postoperative recovery (15)(16)(17). Although ultrasound-guided ESPB is mainly used for adult patients, some pediatric indications have been reported (18)(19)(20).…”