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Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis

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Abstract

Purpose

Although in recent years some randomized controlled trails (RCTs) have explored the analgesic effect of erector spinae plane block (ESPB) in spine surgery, their results are controversial. Our study aimed to examine the analgesic effect of preoperative ESPB in spine surgery by a meta-analysis of RCTs.

Methods

The articles of RCTs that compared preoperative ESPB with no block in terms of the analgesic effect in adult patients following spine surgery were eligible for inclusion. The primary outcome was the pain scores reported by Visual Analog Scale or Numerical Rating Scale of pain at different time intervals in 48 h after surgery. The secondary outcomes included postoperative opioid consumption, rescue analgesia requirement, opioid-related side effects and complications associated with ESPB.

Results

Twelve studies involving 828 patients were eligible for our study. 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 h. ESPB significantly decreased opioid consumption in 24 h 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.

Conclusion

Our meta-analysis demonstrates that ESPB is effective in decreasing postoperative pain intensity and postoperative opioid consumption in spine surgery. Therefore, for the management of postoperative pain following spine surgery, preoperative ESPB is a good choice.

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Abbreviations

RCTs:

Randomized controlled trails

ESPB:

Erector spinae plane block

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PONV:

Postoperative nausea and vomiting

MMA:

Multimodal analgesic

VAS:

Visual analog scale

NRS:

Numerical rating scale of pain

SD:

Standard deviation

SMDs:

Standardized mean differences

WMDs:

Weighted mean differences

CIs:

Confidence intervals

RR:

Relative risk

mTLIP:

Modified-thoracolumbar interfascial plane block

MTP:

Mid-transverse process to pleura block

RLB:

Retrolaminal block

IF:

Incision infiltration

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Funding

Our study did not receive funding.

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Author notes

  1. Jun Ma and Yaodan Bi have contributed to the manuscript equally.

Authors and Affiliations

  1. Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China

    Jun Ma, Yaodan Bi, Yabing Zhang, Yingchao Zhu, Yujie Wu, Yu Ye, Jie Wang, Tianyao Zhang & Bin Liu

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  1. Jun Ma
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Contributions

All authors participated in the formulation of the study design and search strategy. JM, YB and JW searched and selected articles. YW, YY and TZ were responsible for the data extraction. JM, YB, YBZ and YCZ carried out data analysis and drafted the manuscript. All authors contributed to the discussion part. All authors were responsible for the integrity and accuracy of the data and agreed to publish the final version of the article.

Corresponding author

Correspondence to Bin Liu.

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Our study was based on previously published RCTs, and no new patients were enrolled, so informed consent was not required.

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Ma, J., Bi, Y., Zhang, Y. et al. Erector spinae plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. Eur Spine J 30, 3137–3149 (2021). https://doi.org/10.1007/s00586-021-06853-w

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