Pilia Eros, Marrone Francesco, Pusceddu Elisabetta, Sardo Salvatore, Finco Gabriele, Fusco Pierfrancesco
Department of Anesthesia and Intensive Care, G. Brotzu Hospital, Cagliari, Italy.
Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
Indian J Anaesth. 2025 Sep;69(9):873-880. doi: 10.4103/ija.ija_560_25. Epub 2025 Aug 12.
The sacral erector spinae plane block (SESPB) is emerging as a promising ultrasound-guided regional anaesthesia technique for postoperative pain management in various surgical procedures. This systematic review and meta-analysis aimed to investigate the efficacy of SESPB when used in combination with spinal anaesthesia.
We conducted a search of PubMed/MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials, covering literature up to April 2025. Our analysis included randomised controlled trials (RCTs) that compared the outcomes of SESPB used with spinal anaesthesia against spinal anaesthesia alone in patients undergoing elective surgeries. The primary endpoint was the need for rescue opioid analgesics in the postoperative period. Secondary outcomes included postoperative pain levels at 12 and 24 h after surgery, the total amount of opioids consumed in the postoperative period and the time to the first opioid requirement after surgery.
We identified and included three RCTs in the quantitative analysis. The pooled data indicated that SESPB combined with spinal anaesthesia significantly reduced the need for rescue opioid analgesics compared with spinal anaesthesia alone (odds ratio = 0.05; 95% confidence interval = 0.02,0.16; < 0.00001; 14%). Additionally, the use of SESPB was associated with improved postoperative pain management at 24 h, although it did not yield a statistically significant reduction in the total amount of opioid consumed in the postoperative period and the timing of rescue opioid administration.
This meta-analysis of RCTs indicated that the use of SESPB in conjunction with spinal anaesthesia results in a reduced need for rescue opioid analgesics and improved postoperative pain management at 24 h for patients undergoing elective surgery.
骶部竖脊肌平面阻滞（SESPB）正逐渐成为一种有前景的超声引导区域麻醉技术，用于多种外科手术的术后疼痛管理。本系统评价和荟萃分析旨在研究SESPB与脊髓麻醉联合使用时的疗效。
我们检索了PubMed/MEDLINE、EMBASE、ClinicalTrials.gov和Cochrane对照试验中央注册库，涵盖截至2025年4月的文献。我们的分析纳入了随机对照试验（RCT），这些试验比较了在接受择期手术的患者中，SESPB与脊髓麻醉联合使用与单纯脊髓麻醉的效果。主要终点是术后需要使用补救性阿片类镇痛药的情况。次要结局包括术后12小时和24小时的疼痛水平、术后阿片类药物的总消耗量以及术后首次需要使用阿片类药物的时间点。
我们在定量分析中识别并纳入了三项RCT。汇总数据表明，与单纯脊髓麻醉相比，SESPB联合脊髓麻醉显著降低了对补救性阿片类镇痛药的需求（优势比 = 0.05；95%置信区间 = 0.02,0.16；P < 0.00001；I² = 14%）。此外，使用SESPB与术后24小时疼痛管理的改善有关，尽管在术后阿片类药物的总消耗量和补救性阿片类药物给药时间方面没有产生统计学上的显著降低。
这项对RCT的荟萃分析表明，对于接受择期手术的患者，SESPB与脊髓麻醉联合使用可减少对补救性阿片类镇痛药的需求，并改善术后24小时的疼痛管理。
