Background

"Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries."

Methods

"We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model."

Results

"ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis."

Conclusion

"ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile."

Excerpts

Our analyses demonstrated that ESPB’s performance was superior to placebo in all of the aforementioned endpoints, and surpassed TAPB’s in all areas except for nausea and vomiting. Additionally, ESPB demonstrated a similar efficacy in all areas when compared to QLB except for the pain score at 24 h post-operation, and compared well even against intrathecal morphine with a lower participant-reported pain score and PONV, but not a lower rate of postoperative opioid consumption.

The effectiveness of ESPB can be attributed to the dispersion of anesthetics across 3–6 vertebral levels in a downward direction along the spine in the paraspinal area, with the likelihood of spreading to adjacent regions [72, 73]. It has also been suggested that negative intrathoracic pressure and the contraction of the erector spinae muscle may enhance this distribution, contributing to the widespread analgesia observed [74]. These mechanisms facilitate both somatic and visceral pain relief within the corresponding spinal nerve territories [15]. In contrast, TAPB has a predominantly anterior spread, relatively little posterior spread and no spread to the paravertebral spaces [75], and thus has only been reported to offer somatic pain relief [76], which may explain ESPB's superior outcomes in decreasing opioid usage, pain levels, and time to request first rescue analgesic, as demonstrated in our meta-analysis

Citation

Oraee S, Rajai Firouzabadi S, Mohammadi I, Alinejadfard M, Golsorkh H, Hatami S. Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis. BMC Anesthesiol. 2024 Oct 29;24(1):389. doi: 10.1186/s12871-024-02775-4. PMID: 39472781; PMCID: PMC11520691.

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