Bilateral erector spinae plane block for postoperative pain relief in lumbar spine surgery: A PRISMA-compliant updated systematic review & meta-analysis.

STUDY DESIGN

Systematic review.

OBJECTIVE

Erector spinae plane block (ESPB) is growing in popularity over the recent past as an adjuvant modality in multimodal analgesic management following lumbar spine surgery (LSS). The current updated meta-analysis was performed to analyze the efficacy of ESPB for postoperative analgesia in patients undergoing LSS.

METHODS

We conducted independent and duplicate electronic database searches including PubMed, Embase and Cochrane Library till June 2023 for randomized controlled trials (RCTs) analyzing the efficacy of bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Post-operative pain scores, total analgesic consumption, first analgesic requirement time, length of stay and complications were the outcomes evaluated. Statistical analysis was performed using STATA 17 software.

RESULTS

32 RCTs including 1464 patients (ESPB/Control = 1077/1069) were included in the analysis. There was a significant pain relief in ESPB group, as compared to placebo across all timelines such as during immediate post-operative period ( < 0.001), 4 h ( < 0.001), 8 h ( < 0.001), 12 h ( < 0.001), 24 h ( = 0.001) post-surgery. Similarly, ESPB group showed a significant reduction in analgesic requirement at 8 h ( < 0.001), 12 h ( = 0.001), and 24 h ( < 0.001). However, no difference was noted in the first analgesic requirement time, time to ambulate or total length of stay in the hospital. ESPB demonstrated significantly improved overall satisfaction score for the analgesic management ( < 0.001), reduced intensive care stay ( < 0.05) with significantly reduced post-operative nausea and vomiting ( < 0.001) compared to controls.

CONCLUSION

ESPB offers prolonged post-operative pain relief compared to controls, thereby reducing the need for opioid consumption and its related complications.