Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 36; no. 5; pp. 1387 - 1395
• Main Authors: Koo, Chang-Hoon, Lee, Hun-Taek, Na, Hyo-Seok, Ryu, Jung-Hee, Shin, Hyun-Jung
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2022
• Subjects: Analgesia - methods; erector spinae plane block; Humans; Nerve Block - methods; opioid; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Paraspinal Muscles; postoperative pain; Thoracic Surgery; erector spinae plane block; postoperative pain; thoracic surgery; opioid
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2021.06.029

The objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques.
Systematic review and meta-analysis of randomized controlled trials.
PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched.
Patients undergoing thoracic surgeries.
Erector spinae plane block with local anesthetics for postoperative analgesia.
Seventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] –17.49, 95% CI –26.87 to –8.12), pain score at rest (MD –0.82, 95% CI –1.31 to –0.33), and pain score at movement (MD –0.77, 95% CI –1.20 to –0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73).
Erector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.