Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

Abstract

Background: Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. Methods: Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate. Results: A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24 hours after surgery (mean difference [MD] = À4.46, 95% confidence interval [CI] [À5.50 to À3.42], P < 0.001) and in the time to first rescue analgesic (MD = 73.27 minutes, 95% CI [50.39 to 96.15], P < 0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR] = 0.45, 95% CI [0.13 to 1.52], P = 0.20) and vomiting (OR = 0.37, 95% CI [0.10 to 1.35], P = 0.13). No block-related complications were noted. Conclusion: This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy. &

Postoperative analgesic efficacy of the thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA for laparoscopic cholecystectomy: a randomized controlled study

“…Serratus intercostal plane block provides sensory block of T7-T11 dermatomes but is insufficient for midline incisions [6,7,13]. Nevertheless, procedures such as quadratus lumborum blocks, erector spina plane blocks, and thoracic epidural catheters, which give adequate analgesia in laparoscopic cholecystectomy operations, are among the regional anesthesia treatments that cannot be applied or are difficult to apply in the supine position [14][15][16][17][18]. TAPA and m-TAPA blocks were used in the present study after anesthesia induction in the supine position.…”

Pre-incisional Laparoscopic Preperitoneal Local Anesthetic Technique in Laparoscopic Sleeve Gastrectomy

“…The TAP block is a feasible and effective technique for multimodal analgesia following LSG, 21 , 22 while the ESP block 23 , 24 is an effective but relatively new technique to block the spinal nerves innervating the anterior abdominal wall to control postoperative pain after laparoscopic surgery. 25 , 26 Currently, there is insufficient literature comparing ultrasound-guided TAP or ESP blocks with the PLPLAT in terms of efficacy and time required to perform the blocks. 27 , 28 Further studies are needed to assess the efficacy and duration of procedure between PLPLAT and TAP block.…”

Erector spinae plane block for postoperative analgesia. Caution: Meta‐analysis results do not equal science fact

“…To the Editor, In a recent article in this journal, Daghmouri et al 1 reported the findings of a systematic review and metaanalysis of randomized controlled trials (RCTs) of the use of bilateral erector spinae plane block (ESPB) for postoperative analgesia following laparoscopic cholecystectomy. The use of ESPB for a wide range of indications has increased exponentially 2 and there is a clear need for definitive answers about the efficacy of ESPB.…”

“…The use of ESPB for a wide range of indications has increased exponentially 2 and there is a clear need for definitive answers about the efficacy of ESPB. Daghmouri et al 1 found that bilateral ESPB appears to improve the quality of analgesia in the first 24 postoperative hours, and concluded that ESPB is a safe effective alternative option for pain management following laparoscopic cholecystectomy. However, the efficacy of ESPB, and indeed the very concept of interfascial plane blocks, has recently been subjected to scrutiny.…”

“…This could be considered a fundamental methodological flaw in the studies included in the meta-analysis. 1 It has been proposed that in order to determine the efficacy of fascial plane blocks in RCTs, an additional (non-block) control group is included that receives equivalent systemic LA levels to the block group. 3,5 Although current expert opinion is that systemic absorption of LA is unlikely to be a major mechanism of action for the ESPB, 6 it seems entirely appropriate that consideration is given to this possibility in the design of future studies on the efficacy of fascial plane blocks.…”