Erector spinae plane block (ESPB) is effective in decreasing both postoperative pain intensity and postoperative opioid consumption after spine surgery, according to findings from a recent systematic review and meta-analysis which were published in the European Spine Journal by Jun Ma (West China Hospital, Sichuan University, Sichuan, China) et al.
Although in recent years some randomised controlled trails (RCTs) have explored the analgesic effect of ESPB in spine surgery, their results are “controversial”, say the researchers.
This meta-analysis included RCTs that compared preoperative ESPB with no block in terms of the analgesic effect in adult patients following spine surgery.
The primary outcome was pain scores reported by Visual Analog Scale or Numerical Rating Scale of pain at different time intervals up to 48 hours following surgery. Secondary endpoints included postoperative opioid consumption, rescue analgesia requirement, opioid-related side effects and complications associated with ESPB.
A total of 12 studies involving 828 patients were included. Compared with no block, ESPB had a significant effect on reducing postoperative pain scores at rest and at movement at different time intervals except at movement at 48 hours.
ESPB significantly decreased opioid consumption within 24 hours after surgery (SMD − 1.834; 95%CI − 2.752, − 0.915; p<0.001; I2 = 89.0%), and reduced the incidence of rescue analgesia (RR 0.333; 95%CI 0.261, 0.425; p<0.001; I2 = 0%) and postoperative nausea and vomiting (RR 0.380; 95%CI 0.272, 0.530; p < 0.001; I2 = 9.0%). Complications associated with ESPB were not reported in the included studies.
According to Jun Ma et al, these findings show that preoperative ESPB is a “good choice” for the management of postoperative pain following spine surgery.