Bilateral erector spinae plane block for postoperative pain relief in lumbar spine surgery: A PRISMA-compliant updated systematic review & meta-analysis

Abstract

Study design: Systematic review.

Objective: Erector spinae plane block (ESPB) is growing in popularity over the recent past as an adjuvant modality in multimodal analgesic management following lumbar spine surgery (LSS). The current updated meta-analysis was performed to analyze the efficacy of ESPB for postoperative analgesia in patients undergoing LSS.

Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase and Cochrane Library till June 2023 for randomized controlled trials (RCTs) analyzing the efficacy of bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Post-operative pain scores, total analgesic consumption, first analgesic requirement time, length of stay and complications were the outcomes evaluated. Statistical analysis was performed using STATA 17 software.

Results: 32 RCTs including 1464 patients (ESPB/Control = 1077/1069) were included in the analysis. There was a significant pain relief in ESPB group, as compared to placebo across all timelines such as during immediate post-operative period (p < 0.001), 4 h (p < 0.001), 8 h (p < 0.001), 12 h (p < 0.001), 24 h (p = 0.001) post-surgery. Similarly, ESPB group showed a significant reduction in analgesic requirement at 8 h (p < 0.001), 12 h (p = 0.001), and 24 h (p < 0.001). However, no difference was noted in the first analgesic requirement time, time to ambulate or total length of stay in the hospital. ESPB demonstrated significantly improved overall satisfaction score for the analgesic management (p < 0.001), reduced intensive care stay (p < 0.05) with significantly reduced post-operative nausea and vomiting (p < 0.001) compared to controls.

Conclusion: ESPB offers prolonged post-operative pain relief compared to controls, thereby reducing the need for opioid consumption and its related complications.

Keywords: Erector spinae plane block; Lumbar spine surgery; Postoperative pain; Regional anaesthesia; Systematic review.

Fig. 1

PRISMA flow diagram of the included studies.

Fig. 2

Methodological quality and risk of bias assessment of all the included studies.

Fig. 3

Forest plot of the included studies comparing post-operative pain scores at various time points.

Fig. 4

Forest plot of the included studies comparing total analgesic consumption at various time points.

Fig. 5

Forest plot of the included studies comparing the outcome measures like first analgesic requirement time, ambulation time, intensive care period, and length of stay complication rate.

Fig. 6

Forest plot of the included studies comparing the outcome measures like satisfaction score and complication such as post-operative nausea vomitting.

Fig. 7

Funnel plot and galbraith plot for total analgesic consumption in the included studies assessing the publication bias and heterogeneity in the included studies.

Fig. 8

Subgroup analysis showing the forest plot of the included RCTs comparing the outcome measures like pain scores, total analgesic consumption.

Fig. 9

Subgroup analysis showing the forest plot of the included RCTs comparing the total analgesic consumption across different surgery types.

Fig. 10

Illustration on the localization of ESPB needle and spaces of distribution of drug apart from cranio-caudal spread including epidural (1), and paravertebral (2) spaces anteriorly and intercoastal space (3) laterally with ESPB.