Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Valley, Wuhou District, Chengdu, 610041, Sichuan, China.
Eur Spine J. 2021 Nov;30(11):3137-3149. doi: 10.1007/s00586-021-06853-w. Epub 2021 May 13.
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.
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.
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; I = 89.0%), and reduced the incidence of rescue analgesia (RR 0.333; 95%CI 0.261, 0.425; p < 0.001; I = 0%) and postoperative nausea and vomiting (RR 0.380; 95%CI 0.272, 0.530; p < 0.001; I = 9.0%). Complications associated with ESPB were not reported in the included studies.
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.
尽管近年来一些随机对照试验（RCT）已经探索了竖脊肌平面阻滞（ESPB）在脊柱手术中的镇痛效果，但结果存在争议。本研究旨在通过 RCT 的荟萃分析来检验 ESPB 在脊柱手术中的镇痛效果。
纳入比较成人脊柱手术后 ESPB 与无阻滞的镇痛效果的 RCT 文章。主要结局是术后 48 小时内不同时间间隔的视觉模拟评分或数字评分量表报告的疼痛评分。次要结局包括术后阿片类药物消耗量、解救性镇痛需求、阿片类药物相关副作用以及与 ESPB 相关的并发症。
12 项研究共纳入 828 例患者符合本研究标准。与无阻滞相比，ESPB 在不同时间间隔的静息和运动时的术后疼痛评分均有显著降低作用，除运动时的 48 小时外。ESPB 可显著减少术后 24 小时的阿片类药物消耗（SMD -1.834；95%CI -2.752，-0.915；p < 0.001；I = 89.0%），并降低解救性镇痛的发生率（RR 0.333；95%CI 0.261，0.425；p < 0.001；I = 0%）和术后恶心呕吐的发生率（RR 0.380；95%CI 0.272，0.530；p < 0.001；I = 9.0%）。纳入的研究均未报告与 ESPB 相关的并发症。
本荟萃分析表明，ESPB 可有效降低脊柱手术后的术后疼痛强度和术后阿片类药物消耗量。因此，对于脊柱手术后的术后疼痛管理，术前 ESPB 是一个不错的选择。
