Efficacy of erector spinae plane block for postoperative pain management: A meta-analysis and trial sequential analysis of randomized controlled trials

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111831

João Pedro Fernandes Gonçalves, Manuela Lopes Duran, Eduardo Silva Reis Barreto, César Romero Antunes Júnior, Luiz Gustavo Albuquerque, Liliane Elze Falcão Lins-Kusterer PhD, Liana Maria Torres de Araujo Azi MD, PhD, Durval Campos Kraychete MD, PhD

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引用次数: 0

Abstract

Background

Postoperative pain remains a major problem across a wide range of surgical procedures. The efficacy and clinical utility of the Erector Spinae Plane Block (ESPB) in reducing postoperative pain remains uncertain.

Objective

To evaluate the efficacy and safety of the ESPB compared with placebo or sham block in perioperative pain management.

Evidence review

We searched PubMed, Embase, Web of Science, Scopus, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing ESPB to placebo or sham block in surgical patients. Primary outcomes included postoperative pain at 2 h, 6 h, 24 h, and 48 h, intraoperative and cumulative postoperative opioid consumption (24 h), and postoperative nausea and vomiting, pruritus, and block-related adverse events. Subgroup and sensitivity analyses, as well as meta-regressions, were performed to explore sources of heterogeneity. Trial sequential analysis (TSA) was used to assess the quantitative robustness of the available data. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024583633.

Findings

Forty-three RCTs were included, with 1361 patients randomized to the Erector Spinae Plane Block group. ESPB reduced postoperative pain at 2 h (MD −1.46;95 % CI −1.98 to −0.94;p < 0.001;I² = 91 %), 6 h (MD −1.23;95 % CI −1.64 to −0.83;p < 0.001;I² = 89 %), 24 h (MD −0.47;95 % CI −0.67 to −0.28;p < 0.001;I² = 78 %), and 48 h (MD −0.24;95 % CI −0.39 to −0.09;p = 0.002;I² = 10 %). Also, intraoperative opioid consumption (MD -137.43 μg;95 % CI −208.73 to −66.13;p < 0.001;I² = 100 %), 24 h cumulative opioid consumption (MD −25.62 mg;95 % CI −31.31 to −19.93;p < 0.001;I² = 99 %), and incidence of postoperative nausea and vomiting (RR 0.56;95 % CI 0.44 to 0.72;p < 0.001;I² = 16 %) were significantly lower in patients submitted to ESPB. No significant differences were found in postoperative pruritus (RR 0.62;95 % CI 0.35 to 1.10;p = 0.105;I² = 27 %). Notably, no block-related adverse events were reported in any study. Certainty of evidence was rated as low to moderate for most outcomes. TSA suggested that no further trials are needed to assess ESPB efficacy in the analyzed outcomes, except for postoperative pruritus.

Conclusion

ESPB is a safe and effective regional anesthesia technique that significantly reduces postoperative pain and opioid consumption across various surgical procedures.

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竖脊肌平面阻滞治疗术后疼痛的疗效：随机对照试验的荟萃分析和试验顺序分析

背景：术后疼痛仍然是许多外科手术的主要问题。直立脊柱平面阻滞（ESPB）在减轻术后疼痛方面的疗效和临床应用仍不确定。目的评价ESPB与安慰剂、假阻滞治疗围手术期疼痛的疗效和安全性。我们检索了PubMed、Embase、Web of Science、Scopus和Cochrane CENTRAL，查找比较ESPB与安慰剂或假阻断在手术患者中的作用的随机对照试验（rct）。主要结局包括术后2小时、6小时、24小时和48小时疼痛，术中和术后累计阿片类药物消耗（24小时），以及术后恶心和呕吐、瘙痒和阻滞相关不良事件。进行亚组分析和敏感性分析，以及meta回归，以探索异质性的来源。采用试验序列分析（TSA）来评估可用数据的定量稳健性。该综述已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024583633。研究结果纳入43项随机对照试验，1361例患者随机分为直立脊柱平面阻滞组。ESPB减少术后2 h疼痛(MD - 1.46; 95% CI - 1.98至- 0.94;p <；0.001; I2 = 91%), 6 h (MD−1.23;95%可信区间1.64−−0.83;p & lt;0.001; I2 = 89%)、24小时(MD−0.47;95%可信区间0.67−−0.28;p & lt;0.001; I2 = 78%), 48 h (MD−0.24;95%可信区间0.39−−0.09;p = 0.002; I2 = 10%)。术中阿片类药物消耗(MD -137.43 μg; 95% CI - 208.73 ~ - 66.13;p <；0.001;I2 = 100%)， 24 h累计阿片类药物消耗(MD - 25.62 mg; 95% CI - 31.31 ~ - 19.93;p <；0.001;I2 = 99%)，术后恶心呕吐发生率(RR 0.56; 95% CI 0.44 ~ 0.72;p <；0.001;I2 = 16%)，在接受ESPB的患者中显著降低。术后瘙痒无显著性差异（RR 0.62; 95% CI 0.35 ~ 1.10;p = 0.105;I2 = 27%）。值得注意的是，在任何研究中均未报告与阻滞相关的不良事件。大多数结果的证据确定性被评为低到中等。TSA建议，除术后瘙痒外，不需要进一步的试验来评估ESPB在分析结果中的疗效。结论espb是一种安全有效的区域麻醉技术，可显著减少术后疼痛和阿片类药物的消耗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.