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Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis

Authors
Oh, Seok KyeongLim, Byung GunWon, Young JuLee, Dong KyuKim, Seong Shin
Issue Date
Jun-2022
Publisher
Elsevier BV
Keywords
Erector spinae plane block; Neurosurgical procedures; Lumbar vertebrae; Nerve block; Opioid analgesics
Citation
Journal of Clinical Anesthesia, v.78
Indexed
SCIE
SCOPUS
Journal Title
Journal of Clinical Anesthesia
Volume
78
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/55536
DOI
10.1016/j.jclinane.2022.110647
ISSN
0952-8180
Abstract
Study objective 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. Design A meta-analysis of randomized controlled trials. Setting Perioperative setting. Patients Patients undergoing lumbar spine surgery under general anesthesia. Interventions 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. Measurements The primary outcome was opioid consumption in the first 24 h after surgery. Main results 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. Conclusions 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.
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Oh, Seok Kyeong
Guro Hospital (Department of Anesthesiology and Pain Medicine, Guro Hospital)
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