The opioid sparing effect of erector spinae plane block for various surgeries: a meta-analysis of randomized-controlled trials

Fanelli, Andrea; Torrano, Vito; Cozowicz, Crispiana; Mariano, Edward R.; Balzani, Eleonora

doi:10.23736/s0375-9393.21.15356-8

Cited by 15 publications

(8 citation statements)

References 50 publications

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“…We believe these findings suggest that ESPB plays an important role in postoperative analgesia for LC. Moreover, similar to our meta-analysis, a few previous meta-analyses ( 12 – 15 ) demonstrated that the ESPB group had significantly lower pain scores, lower 24-h cumulative opioid consumption, longer time to first rescue analgesia and lower incidence of PONV among patients undergoing surgery. However, these meta-analyses analyzed various surgeries, and as they only contained a small number of trials of abdominal surgery, they could not demonstrate the analgesic effect of ESPB in abdominal surgery.…”

Section: Discussionsupporting

confidence: 88%

“…Our meta-analysis included 24 RCTs and performed a meta-analysis to compare ESPB with placebo or TAPB for postoperative analgesia in abdominal surgery patients based on a larger sample size. Moreover, the quality of trials in these meta-analyses should also be considered, as two of them ( 12 , 15 ) included trials ( 52 ) that have been retracted.…”

Section: Discussionmentioning

confidence: 99%

“…However, thus far, most meta-analyses have focused mainly on validating the effects of ESPB in thoracic or breast surgery and comparing them with thoracic paravertebral blocks, there is a lack of studies exploring their effectiveness in abdominal surgery or comparing them with other trunk blocks such as TAPB. The current meta-analyses ( 12 – 15 ) only included a small number of studies involving abdominal surgery and Daghmouri et al ( 16 ) only researched the effect of ESPB in laparoscopic cholecystectomy (LC).…”

Section: Introductionmentioning

confidence: 99%

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Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials

Gao

Liu²,

Cui³

et al. 2022

Front. Med.

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ObjectivesErector spinae plane block (ESPB) has been used for many thoracic and abdominal surgeries. However, evidence of its analgesic efficacy following abdominal surgery, compared with that of thoracic analgesia, is insufficient. Our study explored the analgesic effect of ESPB after abdominal surgery.MethodsWe searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Primary outcomes were pain scores at 6, 12 and 24 h and 24-h opioid consumption. Secondary outcomes included time to first rescue analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV). We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for primary outcomes and mean differences (MDs) and risk ratios (RRs) with 95% CIs for secondary outcomes.ResultsWe systematically included 1,502 cases in 24 trials. Compared with placebo, ESPB significantly reduced pain scores at 6 h (SMD −1.25; 95% CI −1.79 to −0.71), 12 h (SMD −0.85; 95% CI −1.33 to −0.37) and 24 h (SMD −0.84; 95% CI −1.30 to −0.37) and 24-h opioid consumption (SMD −0.62; 95% CI −1.19 to −0.06) post-surgery. ESPB prolonged the time to first rescue analgesia and decreased the incidence of PONV. Compared with transversus abdominal plane block (TAPB), ESPB significantly reduced pain scores at 6, 12, and 24 h and 24-h opioid consumption and prolonged the time to first rescue analgesia postsurgically. Furthermore, subgroup analysis showed that ESPB significantly reduced pain scores at various time points and opioid consumption within 24 h after laparoscopic cholecystectomy, percutaneous nephrolithotomy and bariatric surgery.ConclusionCompared with placebo, ESPB improves the postoperative analgesic efficacy after abdominal surgery. Furthermore, our meta-analysis confirmed that ESPB provides more beneficial analgesic efficacy than TAPB.Systematic review registration[https://www.crd.york.ac.uk/PROSPEROFILES/301491_STRATEGY_20220104.pdf], identifier [CRD42022301491].

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials

Gao

Liu²,

Cui³

et al. 2022

Front. Med.

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“…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.…”

Section: Discussionsupporting

confidence: 91%

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

Yang

Chen

et al. 2023

BMC Anesthesiol

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Background Laparoscopic cholecystectomy is the gold standard surgical procedure for treating gallstone disease. Despite it being minimally invasive, various medications and methods are used to alleviate postoperative pain, and some patients still experience moderate-to-severe pain. This is a crucial problem that must be solved to avoid chronic pain. As part of postoperative multimodal analgesia, regional block is being increasingly applied in surgery under ultrasound guidance. We aimed to evaluate the analgesic effect of erector spinae plane block in adult patients undergoing laparoscopic cholecystectomy. Methods PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized controlled trials investigating the efficacy of erector spinae plane block on postoperative pain after laparoscopic cholecystectomy. The primary outcome was the postoperative pain score. The secondary outcomes were the cumulative intraoperative and postoperative opioid consumption at 24 h, incidence of postoperative nausea and vomiting, and shoulder pain after surgery. The results were pooled using the fixed- or random-effects model with Review Manager 5.3. Results Fifteen randomized controlled trials involving 947 patients were included in the analysis. Postoperative pain score in the erector spinae plane block group was lower than that in the control group at postoperative 12 h (MD − 0.81, 95% CI − 1.1 to − 0.51, p < 0.00001) and 24 h (MD − 0.41, 95% CI − 0.62 to − 0.19, p = 0.0002). Cumulative opioid consumption was lower in the erector spinae plane block group than in the control group at postoperative 24 h (MD − 7.88, 95% CI − 10.17 to − 5.58, p < 0.00001). The erector spinae plane block group also experienced a lower incidence of postoperative nausea and vomiting than the control group. Opioid consumption and the incidence of postoperative nausea and vomiting were similar between the erector spinae plane block group and other block groups, including the oblique subcostal transversus abdominis plane block and quadratus lumborum block groups. Conclusions Ultrasound-guided erector spinae plane block provides effective postoperative analgesia in adults undergoing laparoscopic cholecystectomy.

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“…Focus on opioid-sparing analgesics and the development of regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery 21 . Opioid-sparing effect and reduced opioid-related adverse effects were reported in ESPB of pectus excavatum surgery 22 and thoracic surgery 23 . In this study, the mean difference of NRS at movement at 4, 8, and 24 hours postoperatively is 0.4, 0.5, and 0.6, statistically significant, but they are not clinically significant.…”

Section: Discussionmentioning

confidence: 99%

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Wang,

et al. 2023

The Clinical Journal of Pain

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Objective: Postoperative analgesia is crucial after video-assisted thoracoscopic surgery (VATS). This study was designed to investigate whether the analgesic effect of programmed intermittent bolus erector spinae plane block (ESPB) is non-inferior to that of intercostal nerve block with patient-controlled intravenous analgesia (ICNB-PCIA) for VATS. Methods: The study was designed as a single-center, open labelled, randomized non-inferiority trial. A total of 80 patients (ASA I–III) undergoing elective video-assisted thoracoscopic lobectomy or bulla resection were randomly allocated to the ICNB-PCIA (n=40) or the ESPB (n=40) group using a programmed intermittent bolus (PIB) injection. The primary outcome was pain intensity at movement at 4 h postoperatively using the Numeric Rating Scale (NRS). Secondary outcomes included pain scores at rest and movement in the recovery room, at 8, 24, and 48 h postoperatively, perioperative analgesics, adverse effects, hospital stay and patient satisfaction. Results: The mean difference in NRS scores at movement at 4 h postoperatively between the ESPB (n=39) and the ICNB-PCIA (n=37) groups was under the non-inferiority margin. NRS scores were significantly higher in the ICNB-PCIA group than the ESPB group at movement postoperatively. At rest, NRS scores were significantly elevated in the ICNB-PCIA at 4 h, 8 h and at 24 h. The postoperative opioids consumption was decreased in the ESPB group. No difference was found in rescue analgesics, hospital stay and patient satisfaction. Discussion: ESPB using a PIB injection offers non-inferior analgesia to ICNB with PCIA after VATS.

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The opioid sparing effect of erector spinae plane block for various surgeries: a meta-analysis of randomized-controlled trials

Cited by 15 publications

References 50 publications

Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials

Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials

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

Programmed Intermittent Bolus for Erector Spinae Plane Block versus Intercostal Nerve Block with Patient-controlled Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

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