Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate. A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24hours after surgery (mean difference [MD]=-4.46, 95% confidence interval [CI] [-5.50 to -3.42], P<0.001) and in the time to first rescue analgesic (MD=73.27minutes, 95% CI [50.39 to 96.15], P<0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR]=0.45, 95% CI [0.13 to 1.52], P=0.20) and vomiting (OR=0.37, 95% CI [0.10 to 1.35], P=0.13). No block-related complications were noted. This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.