The Effects of Erector Spinae Plane Block in Terms of Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials.

Chang-Hoon Koo,Jung-Hee Ryu,Jin-Young Hwang,Hyun-Jung Shin

doi:10.3390/jcm9092928

Abstract

Ultrasound-guided erector spinae plane block (ESPB), a recent regional analgesic technique, has been used to manage acute pain after surgery. The aim of this meta-analysis is to identify the benefits of ESPB in patients undergoing laparoscopic cholecystectomy (LC). The authors searched PubMed, EMBASE, CENTRAL, CINAHL, and Web of Science to identify all randomized controlled trials (RCTs) evaluating the effects of ESPB on postoperative pain after LC. Primary outcome was defined as 24 h cumulative opioid consumption. Secondary outcomes were pain scores and the incidence of postoperative nausea and vomiting (PONV). We estimated mean differences (MD) and odds ratio (OR) using a random-effects model. A total of 8 RCTs, including 442 patients, were included in the final analysis. Postoperative opioid consumption was significantly lower in the ESPB group than in the control group (MD −4.72, 95% CI −6.00 to −3.44, p < 0.001). Compared with the control group, the ESPB group also showed significantly lower pain scores and incidence of PONV. A separate analysis of RCTs comparing ESPB with oblique subcostal transversus abdominis plane (OSTAP) block showed that the analgesic efficacy of ESPB was similar to that of OSTAP block. The results of this meta-analysis demonstrated that ESPB may provide effective postoperative analgesia in patients undergoing LC.

Highlights

Laparoscopic cholecystectomy (LC) is commonly performed with more than 500,000 cases per year to treat gallbladder disease [1]
A total of 8 randomized controlled trials (RCTs) with 442 patients were included in the final analysis (Figure 1) [16,17,18,19,20,21,22,23] 199 patients were allocated to the erector spinae plane block (ESPB) group, 168 patients were allocated to the control group, and 75 patients were allocated to the oblique subcostal transversus abdominis plane (OSTAP) block group
Opioid has long been used as a means to manage acute postoperative and postprocedural pain; a recent study reviewing clinical and administrative data from 135,379 adult patients receiving opioids after hospital-based surgeries or endoscopic procedures reported that 10.6% of the patients experienced opioid-related adverse events, which were related to poor outcomes, including increased inpatient mortality, prolonged length of hospital stay, and higher 30-day readmission rates [27]

Summary

Introduction

Laparoscopic cholecystectomy (LC) is commonly performed with more than 500,000 cases per year to treat gallbladder disease [1]. The advent of ultrasound-guided interfascial plane blocks has been reported in the area of regional anesthesia and pain management. One of the novel techniques introduced in the literature is the erector spinae plane block (ESPB). It was first described in 2016 for the management of thoracic neuropathic pain, and has subsequently been used for acute pain control after surgery [4]. In this technique, a local anesthetic is injected into the fascial plane below the erector spinae muscles. The mechanism of the block is still unclear [5], this novel block has become popular with the increasing number of randomized clinical trials providing its effect

Methods

Results

Conclusion