Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis.

Abstract

OBJECTIVE\nThe objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques.\n\n\nDESIGN\nSystematic review and meta-analysis of randomized controlled trials.\n\n\nSETTING\nPubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched.\n\n\nPARTICIPANTS\nPatients undergoing thoracic surgeries.\n\n\nINTERVENTION\nErector spinae plane block with local anesthetics for postoperative analgesia.\n\n\nMEASUREMENT AND MAIN RESULTS\nSeventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73).\n\n\nCONCLUSION\nErector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.