Efficacy and Safety of Erector Spinae Plane Block in Pain Management for Inguinal Hernia Repair: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Erector spinae plane block (ESPB) is a new anesthetic technique, but its use in inguinal hernia repair remains a subject of debate. We aim to determine the efficacy and safety of ESPB in reducing postoperative pain in inguinal hernia repair in adults.

Methods: We searched MEDLINE, Science Direct, Embase, CENTRAL, ClinicalTrials.gov, and WHO ICTRP for all relevant randomized controlled trials (RCTs) using ESPB in inguinal hernia repair. Two reviewers independently screened the studies, with a third resolving disputes. Risk of bias was assessed using the Cochrane RoB 2 tool. Data were analyzed on R version 4.4.1, using risk ratios (RRs) for dichotomous and mean differences (MDs) for continuous outcomes with 95% confidence intervals (CIs).

Results: Meta-analysis of 6 RCTs revealed no significant reduction in postoperative pain with ESPB at rest or with movement at any time point nor did it significantly lower 24-h opioid consumption. However, in subgroup analysis, ESPB reduced the pain at rest at 12 h in the intraoperative subgroup (p < 0.01) and the 24-h opioid consumption in the intraoperative and the laparoscopic subgroups (p = 0.02). ESPB did not differ significantly from control in time to first rescue analgesia and proportion of patients requiring rescue analgesia. ESPB was not associated with nausea, vomiting, or urinary retention. One study was at high risk of bias, one with some concern, and four at low risk.

Conclusions: ESPB reduces opioid consumption following laparoscopic inguinal hernia repair, but the pain reduction is not clinically significant and the efficacy in open repair is uncertain.