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

Abstract

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.

Evaluation of the Erector spinae plane block for postoperative analgesia in laparoscopic ventral hernia repair: a randomized placebo controlled trial

“…However, our results contrast with results from a meta-analysis done on a composite of abdominal surgeries, where an ESPB was superior to a placebo block [ 2 ]. In other systematic reviews and meta-analyses for more specific abdominal interventions, the ESPB has also been shown to decrease postoperative pain scores, opioid consumption, and the incidence of PONV [ 23 , 24 ].…”

Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial

“…Moreover, interfascial plane blocks closer to epidural space, such as ESP and QL blocks, will likely have a visceral analgesic effect due to epidural spread. However, their visceral analgesic effect is still controversial [ 26 , 27 ], and several meta-analyses have reported a comparable analgesic effect between subcostal TAPB and other interfascial plane blocks [ 28 – 30 ]. Further, a recent meta-analysis reported that subcostal TAPB was associated with the greatest reduction in pain intensity at 12 hours postoperatively and PONV among various regional analgesic techniques [ 6 ].…”

Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block

“…It can be performed at various levels, both thoracic and lumbar, depending on the type of surgery. Several studies have compared the efficacy of these techniques and the superiority of one among others with controversial results [9,10]. Nevertheless, we still do not have a current recommendation for the use of one technique over the others and the choice still relies on the on-duty anesthetist.…”