The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

Abstract

Study Objective Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Design Systematic review of randomized controlled trials (RCTs) with meta-analysis. Setting Postoperative opioid consumption for various surgeries. Patients Patients undergoing various surgeries. Intervention We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. Measurements The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. Results We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of − 12.83 (95% CI: − 17.29 to − 8.38; p < 0.001) mg; I 2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01–6.61; p < 0.001; I 2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I 2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I 2 = 19%). Conclusion ESPB is an effective technique on pain management with few complications.

SP30 Statistically significant but clinically insignificant: no use for ESP block

“…Earlier studies showed no connection between local anesthetic dose and duration. [1][2][3][4] Then, in connection with the development of ultrasound-guided techniques, and dose-finding studies focusing on 'how low can you go', evidence started to emerge showing decreased duration with decreased doses. [5][6][7][8][9] Although the evidence between the previous and more recent studies may seem contradictory, the explanation seems to be that the relationship between local anesthetic dose and duration is not linear.…”

“…LAST, however, is not a complication that only occurs in the operating theatre under the care of anaesthesiologists and many non-anaesthesiologists might often not even be aware of LAST, its recognition and treatment. 1 Traditionally, LAST has been expected to occur after unintentional intravascular injection, however toxic plasma concentrations can also occur secondary to systemic absorption after correct local anaesthetic injection in nerve and fascial plane blocks 2 and also intentional intravenous lidocaine infusion. 3 Various preventative measures can potentially reduce the incidence of LAST events.…”

“…Since Erector Spinae Plane Block (ESP) was first described by Forero et al 1 in 2016, more than 103 prospective, retrospective, animal and paediatric RCTs have been published. 2 There is great interest in ESP block that is seen on plethora of indications and different publications ranging from acute to chronic pain and surgery on upper limb through the trunk and spine to lower limb. 3 -6 Several meta-analyses have shown that ESP block can provide sufficient analgesic effects and reduce postoperative opioid consumption; however, the results are not convincing enough due to the small number of cases included and significant heterogeneity among studies.…”

“…This plane block also reduced time to first analgesia after surgery by 5 hours, but again with considerable heterogeneity. 2 Another meta-analysis from Kyeong et al showed that ESP block provided effective analgesia after lumbar spine surgery. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required.…”

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

“…Lately, under ultrasound guidance, regional blocks have been performed more accurately, providing better postoperative analgesia management [7,8]. The erector spinae plane block (ESPB), first described by Forero et al in 2016 for the treatment of thoracic neuropathic pain [9], has proven effective for acute pain control in abdominal, spinal, breast, and other surgeries [10]. As it can block sympathetic nerve fibers and the ventral rami of spinal nerves [11][12][13]and is easier to perform and safer than paravertebral block, it is quickly gaining popularity among anesthesiologists and applied in various surgeries as a part of multimodal analgesic regimens.…”