Erector spinae plane block for analgesia in children undergoing surgery: A systematic review, meta-analysis and trial sequential analysis.

CONTEXT AND OBJECTIVES

The efficacy of erector spinae plane block (ESPB) analgesia among children undergoing surgery remains unsettled. We aimed to perform an updated systematic review, meta-analysis, and trial sequential analysis to determine whether ESPB is effective for pediatric patients undergoing major surgeries.

METHODS

PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing systemic analgesia with vs. without ESPB in pediatric patients undergoing surgery. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I statistics. Statistical analyses were performed using R Software, version 4.2.3.

RESULTS

We included 10 RCTs, comprising 570 participants, of whom 287 (50,4 %) underwent ESPB. Compared with systemic analgesia alone, ESPB was associated with a lower intraoperative (MD -1.03 μg/kg; 95 % CI -1.73 to -0.33; p < 0.01) and postoperative (MD -0.08 mg/kg; 95 % CI -0.12 to -0.03; p < 0.01) opioid consumption; a longer time to first analgesic requirement (MD 138.76 min; 95 % CI 84.20 to 193.32; p < 0.01); and lower incidence of postoperative nausea and vomiting (PONV) (RR 0.42; 95 % CI 0.23 to 0.77; p < 0.01). There were no differences between groups for postoperative pain at 6 h (SMD -0.61; 95 % CI -1.16 to -0.07; p = 0.03), and 12 h (SMD -0.13; 95 % CI -0.36 to 0.11; p = 0.28); however, postoperative pain at 24 h was lower with ESPB (SMD -0.59; 95 % CI -0.97 to -0.21; p < 0.01).

CONCLUSIONS

In children undergoing surgery, ESPB was associated with lower intra and postoperative opioid consumption, higher time to first analgesic requirement, and lower PONV, but these differences may be of modest clinical significance.