Redefining pain management: investigating the efficacy and safety of erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a meta analysis of randomized controlled trials.

BACKGROUND

Pain following laparoscopic cholecystectomy plays a pivotal role in determining the quality of patient recovery. Considering the opioid crisis, exploration of alternative approaches, such as regional blocks, including erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane block (OSTAPB), has garnered considerable attention due to their promising outcomes in clinical trials.

OBJECTIVE

Our aim is to provide a robust analysis which reflects the most current evidence for the effectiveness and safety of ESPB by comparing it to OSTAPB in adult patients undergoing laparoscopic cholecystectomy.

METHODS

An extensive search was performed in the PubMed, Medline, and Cochrane Library databases from inception to June 1st 2023. Mean difference (SMD), and 95% confidence intervals (CIs) were calculated for continuous outcomes, Risk ratios (RR) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.

RESULTS

A total of 5 RCTs including 372 participants were included in this meta-analysis. Pooled analysis of overall postoperative pain scores at 12 and 24 h showed ESPB to be superior to OSTAPB [MD = -0.67; 95% CI: (-0.95 to -0.39); p < 0.001, I2 = 72%]. ESPB also showed significantly lesser opioid consumption at 24 h postoperatively [MD = -5.36; 95% CI: (-8.56 to -2.15); p < 0.001, I2 = 96%], while intraoperative opioid consumption {MD = -0.46; 95% CI: (-1.27 to -0.36); p = 0.27, I2 = 0%} and postoperative nausea and vomiting were not significantly different between the two groups {RR = 0.40, 95% CI (0.10 to 1.56), p = 0.19; I2 = 56%}.

CONCLUSION

In summary, the erector spinae plane block (ESPB) appears to be the preferred option for acute postoperative pain and opioid reduction in adults undergoing laparoscopic cholecystectomy.