Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

Ying Zhang, Tieshuai Liu, Youfa Zhou, Yijin Yu, Gang Chen, Ying Zhang, Tieshuai Liu, Youfa Zhou, Yijin Yu, Gang Chen

Abstract

Background: Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery.

Methods: We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV).

Results: Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of - 7.67 mg [95% confidence interval (CI) - 10.35 to - 5.00] (P < 0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV.

Conclusions: Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

Keywords: Breast surgery; Erector spinae plane block (ESPB); Opioid consumption; Postoperative analgesia.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the literature search and study selection
Fig. 2
Fig. 2
The risk of bias assessment for included studies. Green, yellow and red circles indicate low, some concerns and high risk of bias, respectively
Fig. 3
Fig. 3
Forest plot of total opioid consumption at the first 24 h after surgery
Fig. 4
Fig. 4
Forest plot of total opioid consumption. (A) total opioid consumption at 1 h postoperatively. (B) total opioid consumption at 6,12 h postoperatively
Fig. 5
Fig. 5
Forest plot of pain scores postoperatively
Fig. 6
Fig. 6
Forest plot of the incidence of postoperative nausea and vomiting (PONV)
Fig. 7
Fig. 7
Forest plot of intraoperative opioid consumption (fentanyl equivalents)
Fig. 8
Fig. 8
Forest plot of postoperative rescue analgesia

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