The erector spinae plane block (ESPB) effectively relieves postoperative pain and decreases opioid consumption following lumbar spinal surgery, according to systematic review and meta-analysis findings published in Journal of Pain Research.
Many patients experience acute severe pain lasting at least 3 days post lumbar spinal surgery that can be detrimental to postoperative rehabilitation if left unmanaged. ESPB is a relatively new alternative to opioid use for such patients. Due to issues associated with post-surgical opioid use, researchers in China sought to determine the efficacy and safety of treating pain following lumbar spinal surgery with ESPB.
After searching the PubMed, Web of Science, Cochrane Library, and EMBASE databases databases through March 2022 for relevant studies, the researchers found 19 randomized controlled trials for analysis. The pooled study population comprised 1381 patients; 691 received ESPB and 690 were in control groups receiving either no block (n=9), saline (n=5), sham block with lidocaine (n=1), or 0.74 mg/kg ketorolac and 10 mg/kg paracetamol (n=1).
decreasing the perioperative consumption of opioids, as well as decreasing the incidence of postoperative opioid-related adverse reactions.
ESPB vs control treatment was associated with decreased use of intraoperative sufentanil (mean difference [MD], -10.88; 95% CI, -17.14 to -4.63; I2=96%; P =.0006) and intraoperative remifentanil (MD, -286.59; 95% CI, -386.94 to -186.25; I2=95%; P <.00001) and with decreased opioid consumption within 24 hours (MD, -9.81; 95% CI, -12.64 to -6.97; I2=97%; P <.00001) and 48 hours (MD, -16.58; 95% CI, -28.99 to -4.16; I2=97%; P =.009) of surgery.
The ESPB intervention was also favored over control for the outcomes of need for rescue analgesia (risk ratio [RR], 0.33; 95% CI, 0.25-0.43; I2=95%; P <.00001), time to rescue analgesia (MD, 373.04; 95% CI, 175.76-570.32; I2=100%; P =.0002), and the number of times patient-controlled intravenous analgesia (PCIA) was used (MD, -13.98; 95% CI, -23.49 to -4.48; I2=98%; P =.004).
Additionally, postoperative pain scores were reported to be significantly lower by ESPB recipients vs control group members at rest between 0 and 8 hours after surgery (MD range, -2.84 to -1.14) and during movement between 8 and 12 hours after surgery (MD range, -1.71 to -1.07).
Compared with control, ESPB was associated with decreased risk for somnolence (RR, 0.28; P =.01), nausea (RR, 0.40; P <.00001), vomiting (RR, 0.43; P =.001), and itching (RR, 0.46; P =.003).
No ESPB-related complications were reported.
The major limitation of this analysis was the high amount of heterogeneity observed in most comparisons.
“ESPB used in lumbar spinal surgery was effective in relieving postoperative pain,
decreasing the perioperative consumption of opioids, as well as decreasing the incidence of postoperative opioid-related adverse reactions,” the study authors concluded.
Fu M-Y, Hao J, Ye L-H, et al. Efficacy and safety of erector spinae plane block for perioperative pain management in lumbar spinal surgery: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2023;16:1453-1475. doi:10.2147/JPR.S402931