The Analgesic Impact of Erector Spinae Plane Block in Inguinal Hernia Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Introduction: The analysis of postoperative pain has gained prominence as an important outcome following inguinal hernia repair (IHR), and various strategies have been employed. However, the use of erector spinae plane block (ESPB) in IHR is debated. Therefore, this systematic review and meta-analysis evaluates their efficacy. Methods: We searched PubMed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs), comparing the impact of ESPB on pain outcomes following IHR. Outcomes included pain using the visual analog scale (VAS) at 2, 6, 12, and 24 hours after surgery and postoperative nausea and vomiting (PONV) rates. Statistical analyses were performed using R software and trial sequential analysis. Results: We included three RCTs comprising 145 patients, of which 66 (45.5%) were submitted to ESPB. Between the included studies, two analyzed minimally invasive IHR, while one analyzed the open Lichtenstein technique. We found no differences in VAS pain scores at 2 hours (MD: -0.56; 95% CI: [-3.53; 2.42]; P = .71) and at 6 hours (MD: -1.13; 95% CI: [-2.50; 0.23]; P = .1) postoperatively. Also, no clinically or statistically significant differences were found in the VAS score for ESPB at 12 hours (MD: -0.96; 95% CI: [-1.94; -.02]; P = .051) and 24 hours postoperatively (MD: -0.19; 95% CI: [-0.53; .15]; P = .28). No statistically significant differences were found in PONV rates between the groups (7.6% versus 20.3%; RR 0.38; 95% CI: [0.14; 1.0]; P = .05). Conclusion: This meta-analysis found no differences in postoperative pain scores or PONV between the ESPB and control groups. Further studies are necessary to better understand the role of ESPB in inguinal hernia repair.