Analgesic effects of erector spinae plane block in patients undergoing nephrectomy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Postoperative pain management remains a massive challenge after renal surgeries. The erector spinae plane block (ESPB) is a promising regional analgesia for pain management after nephrectomy. Unlike other regional anesthesia techniques, ESPB is relatively simple to perform and has been shown to provide effective pain relief in various surgical contexts. We aim to evaluate the analgesic effects of ESPB after nephrectomy, with the goal of providing evidence-based guidance for postoperative pain management in nephrectomy patients.

METHODS

A comprehensive and meticulous literature search was conducted on PubMed, Scopus, Web of Science, and Cochrane Library till September 2024. Review Manager software was used to pool dichotomous and continuous data. We employed the risk of bias tool to evaluate the quality of the evidence, ensuring a thorough and robust analysis.

RESULTS

This systematic review identified fourteen clinical trials of 897 patients that met the inclusion criteria. Meta-analysis results demonstrated that the ESPB significantly reduced pain scores at rest compared to no block at 30 min, 1 h, and 2 h postoperatively (p < 0.00001). In the intermediate recovery phase, ESPB also resulted in significantly lower pain scores at 4, 6, and 12 h (p < 0.001). At 24 h, ESPB continued to show a significant pain reduction compared to no block (SMD = -0.65, p < 0.0001). Less opioid consumption and prolonged time to first rescue analgesia were noticed in ESPB groups (MD = -29.56 mg, p < 0.00001), (SMD = 3.56 min, p = 0.001) respectively. ESPB showed a lower risk of postoperative nausea and vomiting.

CONCLUSION

This review demonstrated significant postoperative analgesic effects of ESPB with lower risks of postoperative nausea and vomiting in nephrectomy. However, the need for further studies to provide conclusive evidence is urgent and paramount in our field.