Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials

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Abstract

Background

Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.

Methods

A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.

Results

A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = − 2.18; 95% confidence interval (CI) -2.76 to − 1.61, p < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66, p = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22, p = 0.0008).

Conclusions

Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.

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Most cited references 18

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The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery

Anahi Perlas, Laith Malhas, Ki Chin (2017)

Postoperative pain after bariatric surgery can be significant and yet difficult to manage. These patients frequently have associated obstructive sleep apnea and are at risk of respiratory depression with opioid analgesia. Abdominal wall blocks such as the subcostal transversus abdominis plane block are not of significant benefit, probably in part because they provide only somatic analgesia. The ultrasound-guided erector spinae plane (ESP) block is a recently described regional anesthetic technique for providing thoracic analgesia when performed at the level of the T5 transverse process. Local anesthetic injected into the fascial plane deep to the erector spinae muscle spreads in a craniocaudal fashion over several levels. Local anesthetic also penetrates anteriorly through the intertransverse connective tissue and enters the thoracic paravertebral space where it can potentially block not only the ventral and dorsal rami of spinal nerves but also the rami communicantes that transmit sympathetic fibers. Coupled with the fact that the erector spinae muscle and ESP extend down to the lumbar spine, this suggests that the ESP block could result in both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level. We describe a series of 3 cases that illustrate the efficacy of bilateral ESP blocks performed at the level of the T7 transverse process for relieving visceral abdominal pain following bariatric surgery. Further investigation is recommended to establish the potential of the ESP block as an analgesic modality in abdominal surgery.

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Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

Serkan Tulgar, Mahmut Kapakli, Ozgur Senturk … (2018)

Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC.

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Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study

Ana Schwartzmann, Philip Peng, Mariano Antunez Maciel … (2018)

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Author and article information

Contributors

Jing-Chen Liu: jingchenl@sina.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 14 April 2020

Publication date PMC-release: 14 April 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 83

Affiliations

GRID grid.412594.f, Department of Anesthesiology, , First Affiliated Hospital of Guangxi Medical University, ; 6 Shuangyong Road, Nanning, 530021 Guangxi Zhuang Autonomous Region People’s Republic of China

Article

Publisher ID: 999

DOI: 10.1186/s12871-020-00999-8

PMC ID: 7155251

PubMed ID: 32290814

SO-VID: ecd3a2d7-ea72-492e-b83b-43083b1c033e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 January 2020

Date accepted : 31 March 2020

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: erector spinae plane block (espb),postoperative analgesia,regional blockade,opioid,pain score

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: erector spinae plane block (espb), postoperative analgesia, regional blockade, opioid, pain score

Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials

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Abstract

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Conclusions

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Irish Journal of Paramedicine

Most cited references 18

The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study

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