The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

Mark C Kendall, Lucas Alves, Lauren L Traill, Gildasio S De Oliveira, Mark C Kendall, Lucas Alves, Lauren L Traill, Gildasio S De Oliveira

Abstract

Background: The effect of erector spinae plane block has been evaluated by clinical trials leading to a diversity of results. The main objective of the current investigation is to compare the analgesic efficacy of erector spinae plane block to no block intervention in patients undergoing surgical procedures.

Methods: We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases from their inception through July 2019. Included trials reported either on opioid consumption or pain scores as postoperative pain outcomes. Methodological quality of included studies was evaluated using Cochrane Collaboration's tool.

Results: Thirteen randomized controlled trials evaluating 679 patients across different surgical procedures were included. The aggregated effect of erector spinae plane block on postoperative opioid consumption revealed a significant effect, weighted mean difference of - 8.84 (95% CI: - 12.54 to - 5.14), (P < 0.001) IV mg morphine equivalents. The effect of erector spinae plane block on post surgical pain at 6 h compared to control revealed a significant effect weighted mean difference of - 1.31 (95% CI: - 2.40 to - 0.23), P < 0.02. At 12 h, the weighted mean difference was of - 0.46 (95% CI: - 1.01 to 0.09), P = 0.10. No block related complications were reported.

Conclusions: Our results provide moderate quality evidence that erector spinae plane block is an effective strategy to improve postsurgical analgesia.

Keywords: Erector spinae plane block; GRADE criteria; Meta-analysis; Postoperative pain.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the selection of studies
Fig. 2
Fig. 2
Postoperative opioid consumption at 24 h. Meta-analysis evaluating the effect of erector spinae plane block on opioid consumption compared to control at 24 h following surgery. The overall effect of the erector spinae plane block versus control was estimated as a random effect. The point estimate for the overall effect was − 8.84 (95%CI: − 12.54 to − 5.14), (P < 0.001) mg IV morphine equivalents. The weighted mean difference for individual studies is represented by the square symbol on Forrest plot, with 95% CI of the difference shown as a solid line
Fig. 3
Fig. 3
Postoperative pain at rest at 6 h, 12 h and at 24 h. The meta-analysis evaluating the effect of erector spinae plane block on pain scores at 6 h (a), at 12 h (b), and at 24 h (c) compared to control was estimated as a random effect. The point estimate for the overall effect on postoperative pain scores at 6 h following surgery was − 1.31 (95% CI: − 2.40 to − 0.23), P < 0.02, (0–10 numerical scale). The point estimate for the overall effect on postoperative pain at 12 h following surgery was − 0.46 (95% CI: − 1.01 to 0.09), P = 0.10. The point estimate for the overall effect on postoperative pain scores at 24 h following surgery was − 0.28 (95% CI: − 0.75 to 0.18), P = 0.23. The weighted mean difference for individual studies is represented by the square symbol on Forrest plot, with 95% CI of the difference shown as a solid line
Fig. 4
Fig. 4
Incidence of postoperative nausea and vomiting at 24 h after surgery. Random-effects meta-analysis evaluating the effect of erector spinae plane block on nausea and vomiting compared to control. Squares to the right of the middle vertical line indicates that erector spinae plane block was associated with increased odds of nausea, whereas squares to the left of the middle vertical line show that erector spinae plane block was associated with decreased odds of nausea. The horizontal lines represent the 95% CI and the diamond shape represents the overall effect of erector spinae plane block on postoperative nausea and vomiting compared to control. CI = confidence interval

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