Abstract
BackgroundErector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.MethodsA systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.ResultsA total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.ConclusionsESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings.Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.
Highlights
One of the ensuing complications of spinal surgery is the post-operative pain that could range from moderate to severe and could have an impact on timing of mobilization and rehabilitation, length of hospital stay, patient satisfaction and could lead to chronic backpain [1–3]
Duration of surgery; mean (SD): 2.13 (0.1) vs. 2.05 (0.08) Visual analogue scale (VAS) score at rest 6 h: 0.5 (0.25) vs. 2 (0) 12 h: 0 (0.25) vs. 2 (0) 24 h: 1 (0.25) vs. 2 (0.25) 48 h: 0 (0) vs. 0 (0.25) VAS score on movement 6 h: 1.5 (0.25) vs. 3 (0) 12 h: 1 (0.25) vs. 3 (0) 24 h: 2 (0.5) vs. 3 (0.25) 48 h: 1 (0) vs. 1 (0.25) Need for rescue analgesic (Sufentanil): relative risks (RR) 0.20 Total opioid consumption; mean (SD): 23.10 (3.1) vs. 36.40 (4.2) Complications Abdominal bloating: RR 0.83 Dizziness: RR 0.67
Duration of surgery; mean (SD): 2.19 (0.19) vs. 2.22 (0.20) Numeric pain rating scale (NRS) score at rest 0–1 h: 1.52 (1.03) vs. 4.08 (1.78) 6 h: 1.92 (0.84) vs. 2.28 (0.70) 12 h: 1.78 (0.81) vs. 2.1 (0.78) 24 h: 1.09 (0.64) vs. 1.46 (0.68) 48 h: 0.57 (0.57) vs. 0.74 (0.63) Total opioid use (Fentanyl, mcg), mean (SD): 100.98 (15.15) vs. 158 (23.38) Intraoperative blood loss; mean (SD): 305.88 (88.12) vs. 437 (116.85) Complications Postoperative nausea and vomiting: RR 0.09 Pruritis: RR 0.09
Summary
One of the ensuing complications of spinal surgery is the post-operative pain that could range from moderate to severe and could have an impact on timing of mobilization and rehabilitation, length of hospital stay, patient satisfaction and could lead to chronic backpain [1–3]. The conventional analgesia model is based on use of opioids and the opioid- related side effects cannot be avoided [6]. These side effects include nausea, vomiting, pruritis, urinary retention and dizziness and could be worrisome for the patients [6]. One of the techniques to reduce post-operative pain and opioid related side effects is multimodal analgesic (MMA) regimen [7]. It involves use of a variety of drugs and delivery mechanisms. Published reviews on this issue have concerning limitations in methodology
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