Article description

Summary:

• To determine the efficacy of erector spinae fascial plane block (ESPB) as the analgesia for acute pain following thoracic surgery and compare the technique with other regional analgesic techniques.
• Systematic review and meta-analysis of randomised controlled trials.
• The study included 17 RCTs with a study population size of 1092 patients.
• High risk of treatment bias.
• Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] 17.49, 95% CI 26.87 to 8.12), pain score at rest (MD 0.82, 95% CI 1.31 to 0.33), and pain score at movement (MD 0.77, 95% CI 1.20 to 0.3) compared to no block.
• Paravertebral block (PVB) provides significantly lower passive and dynamic pain scores and less rescue analgesia than ESPB.
• Compared to intercostal nerve blocks (ICBs), passive and dynamic pain scores were not significantly different from ESPBs but required significantly greater rescue analgesia.
• Compared to serratus anterior fascial plane blocks (SAPBs), passive pain scores were not significantly different from ESPBs but dynamic pain scores were significantly lower and less rescue analgesia was required.
• All meta-analyses of pain scores had high level of heterogeneity.
• ESPB was associated with a significant lower incidence of haematoma compared to the pooled ICB, PVB and SAPB incidence.

Conclusions:

• ESPB provides effective analgesia.
• Compared with PVB, SAPB, and ICB, ESPB may be a valuable option for controlling postoperative pain.