Efficacy of erector spinae nerve block for pain control after lumbar spinal surgeries: a systematic review and meta-analysis

X.-J. Cao, S.-B. Zhang, Y. Liang

Department of Rehabilitation Medicine, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China. liangyan2209@163.com

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• Surgery

OBJECTIVE: The review aimed to examine the evidence on the efficacy of erector spinae nerve block (ESPB) for pain control after lumbar spinal surgeries.

MATERIALS AND METHODS: PubMed, CENTRAL, Embase, and Web of Science were examined for published randomized controlled trials (RCTs) assessing ESPB with control for lumbar spinal surgery patients. The primary review outcome was 24-hour total opioid consumption in morphine equivalents. The secondary review outcomes were pain at rest at 4-6 hours, 8-12 hours, 24 hours and 48 hours, first rescue analgesic timing, needing rescue analgesics number, and postoperative nausea and vomiting (PONV).

RESULTS: 16 trials were eligible. Total opioid consumption was significantly lower with ESPB as compared to controls (MD: -12.68 95% CI: -18.09, -7.28 I2=99% p<0.00001). Pain scores at 4-6 hours (MD: -1.37 95% CI: -1.98, -0.76 I2=95% p<0.0001), 8-12 hours (MD: -1.18 95% CI:-1.84, -0.52 I2=98% p=0.0004), 24 hours (MD: -0.53 95% CI:-1.03, -0.04 I2=96% p=0.04) and 48 hours (MD: -0.36 95% CI:-0.84, 0.13 I2=88% p=0.15) were significantly lower in the ESPB group. The meta-analysis found that the ESPB group required a significantly longer time for the first analgesic request (MD: 5.26 95% CI: 2.53, 7.99 I2=100% p=0.002), had lower demand for rescue analgesics (OR: 0.12 95% CI: 0.07, 0.21 I2=2% p<0.00001) and fewer incidence of PONV (OR: 0.27 95% CI: 0.15, 0.49 I2=51% p<0.0001).

CONCLUSIONS: ESPB can be highly efficacious for postoperative analgesia in lumbar surgery patients. The block has the capability of reducing opioid consumption in the first 24 hours and pain scores up to 48 hours along with a significant reduction in the need for rescue analgesics and PONV.

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