Oliveira Camila N B de, Graziani E Sousa Augusto, Balthazar da Silveira Carlos A, Kasakewitch João P G, Camacho Diego, Malcher Flavio, Lima Diego L
Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
Centro Universitário de Anápolis, Anápolis, Brazil.
J Laparoendosc Adv Surg Tech A. 2025 Jun;35(6):445-450. doi: 10.1089/lap.2025.0020. Epub 2025 Apr 26.
The analysis of postoperative pain has gained prominence as an important outcome following inguinal hernia repair (IHR), and various strategies have been employed. However, the use of erector spinae plane block (ESPB) in IHR is debated. Therefore, this systematic review and meta-analysis evaluates their efficacy. We searched PubMed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs), comparing the impact of ESPB on pain outcomes following IHR. Outcomes included pain using the visual analog scale (VAS) at 2, 6, 12, and 24 hours after surgery and postoperative nausea and vomiting (PONV) rates. Statistical analyses were performed using R software and trial sequential analysis. We included three RCTs comprising 145 patients, of which 66 (45.5%) were submitted to ESPB. Between the included studies, two analyzed minimally invasive IHR, while one analyzed the open Lichtenstein technique. We found no differences in VAS pain scores at 2 hours (MD: -0.56; 95% CI: [-3.53; 2.42]; = .71) and at 6 hours (MD: -1.13; 95% CI: [-2.50; 0.23]; = .1) postoperatively. Also, no clinically or statistically significant differences were found in the VAS score for ESPB at 12 hours (MD: -0.96; 95% CI: [-1.94; -.02]; = .051) and 24 hours postoperatively (MD: -0.19; 95% CI: [-0.53; .15]; = .28). No statistically significant differences were found in PONV rates between the groups (7.6% versus 20.3%; RR 0.38; 95% CI: [0.14; 1.0]; = .05). This meta-analysis found no differences in postoperative pain scores or PONV between the ESPB and control groups. Further studies are necessary to better understand the role of ESPB in inguinal hernia repair.
术后疼痛分析已成为腹股沟疝修补术（IHR）后的一项重要结果，并且已经采用了各种策略。然而，竖脊肌平面阻滞（ESPB）在IHR中的应用存在争议。因此，本系统评价和荟萃分析评估了其疗效。我们在PubMed、Embase、Cochrane和Web of Science中检索了随机对照试验（RCT），比较ESPB对IHR后疼痛结果的影响。结果包括术后2、6、12和24小时使用视觉模拟量表（VAS）评估的疼痛以及术后恶心呕吐（PONV）发生率。使用R软件进行统计分析并进行试验序贯分析。我们纳入了三项RCT，共145例患者，其中66例（45.5%）接受了ESPB。在纳入的研究中，两项分析了微创IHR，一项分析了开放的Lichtenstein技术。我们发现术后2小时（MD：-0.56；95%CI：[-3.53；2.42]；P =.71）和6小时（MD：-1.13；95%CI：[-2.50；0.23]；P =.1）时VAS疼痛评分无差异。此外，术后12小时（MD：-0.96；95%CI：[-1.94；-.02]；P =.051）和24小时（MD：-0.19；95%CI：[-0.53；.15]；P =.28）时ESPB的VAS评分在临床或统计学上也无显著差异。两组之间的PONV发生率无统计学显著差异（7.6%对20.3%；RR 0.38；95%CI：[0.14；1.0]；P =.05）。这项荟萃分析发现ESPB组和对照组在术后疼痛评分或PONV方面无差异。有必要进行进一步研究以更好地了解ESPB在腹股沟疝修补术中的作用。
