Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study

Background: Erector spinae plane block could be a potential alternative to paravertebral blockor other analgesic techniques for breast surgery, but the current evidence on erector spinae planeblock in breast surgery is conflicting.Objective: To compare the analgesic effectiveness between erector spinae plane block, systemicanalgesic, and paravertebral block for breast surgery.Study Design: Meta-analysis.Setting: The literature search was performed from 2016 to August 2020 using the MEDLINE,EMBASE, Cochrane library, and ClinicalTrials.gov databases.Methods: Clinical trials comparing erector spinae plane block to systemic analgesic andparavertebral block were included from the aforementioned databases. Primary outcomes were24-hour postoperative opioid administration and postoperative pain score. Secondary outcomeswere patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related sideeffects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysiswere performed according to the PRISMA statement.Results: We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemicanalgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperativeintravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Comparedwith paravertebral block, no statistical difference was found in opioid administration. Nodifferences were observed in pain score, opioid-related side effects, or analgesic technique-relatedcomplications. Between the trials, heterogeneity existed and could not be evaluated using metaregressionowing to inadequate reported data.Limitations: Moderate heterogeneity among the included trials could not be assessed bypotential covariates owing to the limited reported data in each trial.Conclusion: Erector spinae plane block is superior to systemic analgesic within 24 hours afterbreast surgery and can serve as an alternative to paravertebral block with similar analgesic effects.Key words: Erector spinae plane block, paravertebral block, breast surgery, perioperativeanalgesia, randomized controlled trial, meta-analysis