Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis
Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. A meta-analysis of randomized contr...
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| Published in: | Journal of clinical anesthesia Vol. 78; p. 110647 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
Elsevier Inc
01.06.2022
Elsevier Limited |
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| ISSN: | 0952-8180, 1873-4529, 1873-4529 |
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| Abstract | Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.
A meta-analysis of randomized controlled trials.
Perioperative setting.
Patients undergoing lumbar spine surgery under general anesthesia.
We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.
The primary outcome was opioid consumption in the first 24 h after surgery.
Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = −14.55; 95% confidence interval (CI), −21.03 to −8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0−10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = −1.24 days; 95% CI, −2.31 to −0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.
ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required.
PROSPERO registration number: CRD42021233362.
•Evidence for ESPB use in lumbar spine surgery is insufficient.•We performed evidence synthesis of 12 RCTs on ESPB vs. control for lumbar surgery.•ESPB improved analgesic efficacy by reducing opioid consumption 24 h after surgery.•ESPB increased patient satisfaction and decreased postoperative nausea and vomiting.•ESPB at the incision/operation level reduced opioid use more than at the fixed level. |
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| AbstractList | AbstractStudy objectiveErector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. DesignA meta-analysis of randomized controlled trials. SettingPerioperative setting. PatientsPatients undergoing lumbar spine surgery under general anesthesia. InterventionsWe searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery. MeasurementsThe primary outcome was opioid consumption in the first 24 h after surgery. Main resultsTwelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = −14.55; 95% confidence interval (CI), −21.03 to −8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0−10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = −1.24 days; 95% CI, −2.31 to −0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed. ConclusionsESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362. Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.STUDY OBJECTIVEErector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.A meta-analysis of randomized controlled trials.DESIGNA meta-analysis of randomized controlled trials.Perioperative setting.SETTINGPerioperative setting.Patients undergoing lumbar spine surgery under general anesthesia.PATIENTSPatients undergoing lumbar spine surgery under general anesthesia.We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.INTERVENTIONSWe searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.The primary outcome was opioid consumption in the first 24 h after surgery.MEASUREMENTSThe primary outcome was opioid consumption in the first 24 h after surgery.Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.MAIN RESULTSTwelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362.CONCLUSIONSESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362. Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. A meta-analysis of randomized controlled trials. Perioperative setting. Patients undergoing lumbar spine surgery under general anesthesia. We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery. The primary outcome was opioid consumption in the first 24 h after surgery. Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = −14.55; 95% confidence interval (CI), −21.03 to −8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0−10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = −1.24 days; 95% CI, −2.31 to −0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed. ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362. •Evidence for ESPB use in lumbar spine surgery is insufficient.•We performed evidence synthesis of 12 RCTs on ESPB vs. control for lumbar surgery.•ESPB improved analgesic efficacy by reducing opioid consumption 24 h after surgery.•ESPB increased patient satisfaction and decreased postoperative nausea and vomiting.•ESPB at the incision/operation level reduced opioid use more than at the fixed level. Study objectiveErector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.DesignA meta-analysis of randomized controlled trials.SettingPerioperative setting.PatientsPatients undergoing lumbar spine surgery under general anesthesia.InterventionsWe searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.MeasurementsThe primary outcome was opioid consumption in the first 24 h after surgery.Main resultsTwelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = −14.55; 95% confidence interval (CI), −21.03 to −8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0−10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = −1.24 days; 95% CI, −2.31 to −0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.ConclusionsESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required.PROSPERO registration number: CRD42021233362. Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. A meta-analysis of randomized controlled trials. Perioperative setting. Patients undergoing lumbar spine surgery under general anesthesia. We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery. The primary outcome was opioid consumption in the first 24 h after surgery. Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed. ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362. |
| ArticleNumber | 110647 |
| Author | Oh, Seok Kyeong Lim, Byung Gun Kim, Seong Shin Lee, Dong Kyu Won, Young Ju |
| Author_xml | – sequence: 1 givenname: Seok Kyeong surname: Oh fullname: Oh, Seok Kyeong – sequence: 2 givenname: Byung Gun surname: Lim fullname: Lim, Byung Gun email: bglim9205@korea.ac.kr – sequence: 3 givenname: Young Ju surname: Won fullname: Won, Young Ju – sequence: 4 givenname: Dong Kyu surname: Lee fullname: Lee, Dong Kyu – sequence: 5 givenname: Seong Shin surname: Kim fullname: Kim, Seong Shin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35030493$$D View this record in MEDLINE/PubMed |
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| Keywords | Erector spinae plane block Nerve block Lumbar vertebrae Neurosurgical procedures Opioid analgesics |
| Language | English |
| License | This is an open access article under the CC BY-NC-ND license. Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved. |
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| PublicationCentury | 2000 |
| PublicationDate | 2022-06-01 |
| PublicationDateYYYYMMDD | 2022-06-01 |
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| PublicationTitle | Journal of clinical anesthesia |
| PublicationTitleAlternate | J Clin Anesth |
| PublicationYear | 2022 |
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| Snippet | Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains... AbstractStudy objectiveErector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in... Study objectiveErector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar... |
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| SubjectTerms | Analgesics Analgesics, Opioid Anesthesia Back surgery Bias Erector spinae plane block Humans Length of stay Lumbar vertebrae Meta-analysis Narcotics Nerve block Nerve Block - methods Neurosurgical procedures Opioid analgesics Pain Pain Medicine Pain, Postoperative - etiology Pain, Postoperative - prevention & control Paraspinal Muscles Patient satisfaction Postoperative Nausea and Vomiting - epidemiology Postoperative Nausea and Vomiting - etiology Postoperative Nausea and Vomiting - prevention & control Systematic review Thoracic surgery Ultrasonic imaging Vertebrae |
| Title | Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis |
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