ObjectivesThis study conducted a meta-analysis basing on the available evidences from randomized controlled trials (RCTs), with the aim of assessing the efficacy and safety of bilateral ultrasound-guided erector spinae plane block (US-ESPB) for post-operative analgsia in patients receiving spine surgery. MethodsThe PubMed, EMBASE and CENTRAL were searched by two reviewers independently, to identify the RCTs evaluating the efficacy of US-ESPB for pain management in patients undergone spine surgery. During performing the meta-analyses, the mean difference (MD) and 95% confidence interval (95%CI) were selected for continuous data, while risk ratio (RR) and 95%CI were selected for dichotomous variables. ResultsA total of 25 RCTs, including 1917 patients (873 in ESPB group and 874 in control group), were eligible for inclusion. ESPB was associated with significant lower pain intensity at 0, 2, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group at rest. During movement, ESPB was associated with significant lower pain intensity at 0, 4, 6, 8, 12, 24, and 48 hours, when compared to the control group. Significantly reduced opioid consumption (MD = -6.29, 95%CI: -8.16∼ -4.41, p<0.001***), prolonged time for first rescue analgesia (MD = 7.51, 95%CI: 3.47∼11.54, p<0.001***), fewer patients needing rescue analgesia (RR = 0.34, 95%CI: 0.28∼0.43, p<0.0001***), improved patients’ satisfactory (MD = 1.34, 95%CI: 0.88∼1.80, p<0.001***), and shorter length of hospital stay (MD = -0.38, 95%CI: -0.50∼-0.26, p<0.001***) were demonstrated after applying of ESPB. Additionally, ESPB was associated with decreased risks of any adverse event (RR = 0.51, 95%CI: 0.43∼0.60, p<0.001***) and PONV events (RR = 0.39, 95%CI: 0.31∼0.49, p<0.001***). ConclusionUS-ESPB is an effective adjunctive technique with good tolerability for multimodal analgesia in the management of pain in patients undergoing spine surgery.