Oliveira Dora A C, Ferreira Rafael O M, Picado-Loaiza Susimar, Pedrotti Matheus, Santos Henrique V, Pasqualotto Eric, Filardi Rafaela G M
Department of Anesthesiology, Coimbra University and Medical Center, Coimbra, Portugal.
Surgery Department, Federal University of Santa Catarina, Santa Catarina, Brazil.
J Clin Anesth. 2025 Jun;104:111861. doi: 10.1016/j.jclinane.2025.111861. Epub 2025 May 6.
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.
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.
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).
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.
竖脊肌平面阻滞（ESPB）用于儿童手术镇痛的效果尚无定论。我们旨在进行一项更新的系统评价、荟萃分析和试验序贯分析，以确定ESPB对接受大手术的儿科患者是否有效。
系统检索PubMed、Embase和Cochrane图书馆，查找比较接受手术的儿科患者使用ESPB与未使用ESPB进行全身镇痛的随机对照试验（RCT）。我们计算了连续结局的平均差（MD）或标准化平均差（SMD）以及二分类结局的风险比（RR），并给出95%置信区间（CI）。使用I统计量评估异质性。使用R软件4.2.3版进行统计分析。
我们纳入了10项RCT，共570名参与者，其中287名（50.4%）接受了ESPB。与单纯全身镇痛相比，ESPB与术中（MD -1.03μg/kg；95%CI -1.73至-0.33；p<0.01）和术后（MD -0.08mg/kg；95%CI -0.12至-0.03；p<0.01）阿片类药物消耗量较低、首次需要镇痛的时间较长（MD 138.76分钟；95%CI 84.20至193.32；p<0.01）以及术后恶心呕吐（PONV）发生率较低（RR 0.42；95%CI 0.23至0.77；p<0.01）相关。两组在术后6小时（SMD -0.61；95%CI -1.16至-0.07；p = 0.03）和12小时（SMD -0.13；95%CI -0.36至0.11；p = 0.28）的疼痛方面无差异；然而，ESPB组术后24小时的疼痛较轻（SMD -0.59；95%CI -0.97至-0.21；p<0.01）。
在接受手术的儿童中，ESPB与术中及术后阿片类药物消耗量较低、首次需要镇痛的时间较长以及PONV发生率较低相关，但这些差异可能具有适度的临床意义。
