Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis
Erector spinae plane block (ESPB) is a regional block that may be used for several surgeries. However, the evidence regarding obstetrical procedures is not pooled in the literature.
to assess whether ESPB improves the postoperative pain after cesarean section by a systematic review and meta-analysis.
The protocol of this review was registered on PROSPERO (CRD42020192760). We included randomized controlled trials from databases until August 2020. The primary outcome was pain measured on a visual analogic scale; secondary outcomes were analgesic duration, postoperative opioid dose within the 24 hours, nausea/vomiting. The risk of bias and the GRADE criteria to assess quality of evidence were analyzed.
From 436 retrieved studies, three were selected. There was no difference in the pain scores between ESPB and controls at rest after surgery at 4 h (mean difference [MD] = 0.00; 95% CI: -0.72 to 0.72; I² = 0%; very low certainty), 12 h (MD = -1.00; 95% CI: -2.00 to -0.00; I² = 0%, low certainty) and 24 h (MD = -0.68; 95% CI: -1.56 to 0.20; I² = 50%; very low certainty). There was a smaller consumption of tramadol with ESPB compared with controls (MD = -47.66; 95% CI: -77.24 to -18.08; I² = 59%; very low certainty). The analgesic duration of ESPB was longer than the controls (MD = 6.97; 95% CI: 6.30 to 7.65; I² = 58%; very low certainty).
ESPB did not decrease the postoperative pain scores when compared to other comparators. However, ESPB showed a lower consumption of tramadol and a longer blockade duration, although the quality of evidence of these outcomes were very low.
1 A.P. Betrán, J. Ye, A.-B. Moller, et al. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014 PLos One, 11 (2016), Article e0148343
2 G.A. Macones, A.B. Caughey, S.L. Wood, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3) Am J Obstet Gynecol, 221 (2019) 247.e1–247.e9
3 K.D. Mitchell, C.T. Smith, C. Mechling, et al. A review of peripheral nerve blocks for cesarean delivery analgesia Reg Anesth Pain Med, 45 (2020), pp. 52-62
4 M. Forero, S.D. Adhikary, H. Lopez, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain Reg Anesth Pain Med, 41 (2016), pp. 621-627
5 D.P. Santonastaso, A. de Chiara, A. Addis, et al. Ultrasound guided erector spinae plane block for post-operative pain control after caesarean section J Clin Anesth, 58 (2019), pp. 45-46
6 E.M. Helander, M.P. Webb, J. Kendrick, et al. PECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review Best Pract Res Clin Anaesthesiol, 33 (2019), pp. 573-581
7 H.-M. Kwon, D.-H. Kim, S.-M. Jeong, et al. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect?: A Randomized Controlled Trial Sci Rep, 10 (2020), p. 8389
8 M. Canturk Ultrasound-guided lumbar erector spinae plane block: The sole anesthetic method for emergent strangulated inguinal herniorrhaphy for a patient on anticoagulant treatment J Clin Anesth, 61 (2020), Article 109685
9 J.A. Herman, I. Urits, A.D. Kaye, et al. Erector Spinae Plane Block (ESPB) or Quadratus Lumborum Block (QLB-II) for laparoscopic cholecystectomy: Impact on postoperative analgesia J Clin Anesth, 66 (2020), Article 109958
10 H. Aygun, N. Kavrut Ozturk, A.S. Pamukcu, et al. Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study J Clin Anesth, 62 (2020), Article 109696
11 A. Abdelnasser, H. Zoheir, A. Rady, et al. Effectiveness of ultrasound-guided erector spinae plane block for postoperative pain control in hip replacement surgeries; A pilot study J Clin Anesth, 62 (2020), Article 109732
12 A.A.F. Kamel, O.A.I. Amin, M.A.M. Ibrahem Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy Pain Physician, 23 (2020), pp. 375-382
13 Y. Gürkan, C. Aksu, A. Kuş, et al. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial J Clin Anesth, 59 (2020), pp. 84-88
14 W. Huang, W. Wang, W. Xie, et al. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis J Clin Anesth, 66 (2020), Article 109900
15 J. Huang, J.-C. Liu Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials BMC Anesthesiol, 20 (2020), p. 83
16 PRISMA-P Group, D. Moher, L. Shamseer, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement Syst Rev, 4 (2015), p. 1
17 Idelberto do val Ribeiro Junior, Luiz Gustavo Oliveira Brito, Vanessa Henriques Carvalho. PROSPERO 2020 CRD42020192760 [Internet]. Erector spinae plane block for analgesia after cesarean delivery. A systematic review with meta-analysis. Available into: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192760.
18 C. Schardt, M.B. Adams, T. Owens, et al. Utilization of the PICO framework to improve searching PubMed for clinical questions BMC Med Inform Decis Mak, 7 (2007), p. 16
19 M.L. Boules, A.S. Goda, M.A. Abdelhady, et al. Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study J Pain Res, 13 (2020), pp. 1073-1080
20 M.A. Hamed, H.M. Yassin, J.M. Botros, et al. Analgesic Efficacy of Erector Spinae Plane Block Compared with Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study J Pain Res, 13 (2020), pp. 597-604
21 A. Malawat, K. Verma, D. Jethava, et al. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study J Anaesthesiol Clin Pharmacol, 36 (2020), p. 201
22 J.P.T. Higgins, D.G. Altman, P.C. Gotzsche, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials BMJ, 343 (2011), p. d5928
23 G.H. Guyatt, A.D. Oxman, G.E. Vist, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations BMJ, 336 (2008), pp. 924-926
24 Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration (2020)
25 Q. Cai, G. Liu, L. Huang, et al. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials Int J Surg, 80 (2020), pp. 107-116
26 A. Borgeat, G. Ekatodramis, C.A. Schenker Postoperative Nausea and Vomiting in Regional Anesthesia: A Review Anesthesiology, 98 (2003), pp. 530-547
27 Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management Anesthesiology, 116 (2012), pp. 248-273
28 S.N. Krishna, S. Chauhan, D. Bhoi, et al. Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial J Cardiothorac Vasc Anesth, 33 (2019), pp. 368-375
29 M. El Ghamry, A. Amer Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial Indian J Anaesth, 63 (2019), p. 1008
30 R.A. Moore, R.J.N. Mhuircheartaigh, S. Derry, et al. Mean analgesic consumption is inappropriate for testing analgesic efficacy in post-operative pain: analysis and alternative suggestion Eur J Anaesthesiol, 28 (2011), pp. 427-432
31 R.W. Leong, E.S.J. Tan, S.N. Wong, et al. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis Anaesthesia, 76 (2021), pp. 404-413
32 H. Ueshima Pneumothorax after the erector spinae plane block J Clin Anesth, 48 (2018), p. 12
33 O. Selvi, S. Tulgar Ultrasound guided erector spinae plane block as a cause of unintended motor block Rev Esp Anestesiol Reanim Engl Ed, 65 (2018), pp. 589-592
34 A. Elkoundi, Z. Eloukkal, M. Bensghir, et al. Priapism following erector spinae plane block for the treatment of a complex regional pain syndrome Am J Emerg Med, 37 (2019) 796.e3-796.e4
35 DL Hamilton Pneumothorax following erector spinae plane block J Clin Anesth, 52 (2019), p. 17