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Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta‐analysis of Randomized Controlled Trials
Author(s) -
Daghmouri Mohamed Aziz,
Akremi Soumaya,
Chaouch Mohamed Ali,
Mesbahi Meryam,
Amouri Nouha,
Jaoua Hazem,
Ben Fadhel Kamel
Publication year - 2021
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12953
Subject(s) - medicine , confidence interval , randomized controlled trial , meta analysis , anesthesia , analgesic , odds ratio , nausea , postoperative nausea and vomiting , vomiting , laparoscopic cholecystectomy , cholecystectomy , surgery
Background 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. Methods 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. Results 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 24 hours 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 = 73.27 minutes, 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. Conclusion 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.