The Efficacy of Erector Spinae Plane Block for Thoracoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials

Authors

  • Ling Liu Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, 400030 Chongqing, China
  • Yuhua Zhao Department of Orthopedics, The First Affiliated Hospital of Army Medical University, 400030 Chongqing, China
  • Yongpeng He Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, 400030 Chongqing, China
  • WenLi Peng Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, 400030 Chongqing, China
  • Huan He Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, 400030 Chongqing, China
  • Ling Liang Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, 400030 Chongqing, China

DOI:

https://doi.org/10.59958/hsf.5349

Keywords:

erector spinae plane block, thoracoscopic surgery, randomized controlled trials, meta-analysis

Abstract

Background: The efficacy of erector spinae plane block for thoracoscopic surgery remains controversial. We conducted a systematic review and meta-analysis to explore the impact of erector spinae plane block on thoracoscopic surgery. Methods: We searched the PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through February 2022 for randomized controlled trials (RCTs), assessing the effect of erector spinae plane block on thoracoscopic surgery. This meta-analysis was performed using the random-effect model. Results: Seven RCTs, involving 439 patients, are included in the meta-analysis. Overall, compared with the control group for thoracoscopic surgery, erector spinae plane block (ESPB) results in significantly reduced pain scores at 1 h (standard mean difference (SMD) = –4.26; 95% confidence interval (CI) = –7.63 to –0.88; p = 0.01), 4 h (SMD = –4.08; 95% CI = –4.56 to –3.60; p < 0.00001), 8 h (SMD = –4.13; 95% CI = –4.62 to –3.65; p < 0.00001), and postoperative anesthesia consumption (SMD = –3.04; 95% CI = –4.58 to –1.50; p = 0.0001) and can decrease the incidence of nausea and vomiting (odd ratio (OR) = 0.18; 95% CI = 0.08 to 0.39; p < 0.001). Conclusions: ESPB can substantially enhance pain relief for thoracoscopic surgery.

References

Murakawa T, Sato H, Okumura S, Nakajima J, Horio H, Ozeki Y, et al. Thoracoscopic surgery versus open surgery for lung metastases of colorectal cancer: a multi-institutional retrospective analysis using propensity score adjustment†. European Journal of Cardio-Thoracic Surgery. 2017; 51: 1157–1163.

Kinjo Y, Kurita N, Nakamura F, Okabe H, Tanaka E, Kataoka Y, et al. Effectiveness of combined thoracoscopic–laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surgical Endoscopy. 2012; 26: 381–390.

Pham TH, Perry KA, Dolan JP, Schipper P, Sukumar M, Sheppard BC, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor–Lewis esophagectomy. The American Journal of Surgery. 2010; 199: 594–598.

Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials. British Journal of Anaesthesia. 2006; 96: 418–426.

Sztain JF, Gabriel RA, Said ET. Thoracic Epidurals are Associated with Decreased Opioid Consumption Compared to Surgical Infiltration of Liposomal Bupivacaine Following Video-Assisted Thoracoscopic Surgery for Lobectomy: a Retrospective Cohort Analysis. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33: 694–698.

Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian Journal of Anaesthesia. 2018; 62: 75–78.

Wang X, Wang K, Wang B, Jiang T, Xu Z, Wang F, et al. Effect of Oxycodone Combined with Dexmedetomidine for Intravenous Patient-Controlled Analgesia after Video-Assisted Thoracoscopic Lobectomy. Journal of Cardiothoracic and Vascular Anesthesia. 2016; 30: 1015–1021.

Zhang Y, He B, Zhao J, Zhang M, Ren Q, Zhang W, et al. Addition of Celebrex and Pregabalin to Ropivacaine for Posterior Spinal Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial. Drug Design, Development and Therapy. 2021; 15: 735–742.

Zhao J, Zhang S, Li X, He B, Ou Y, Jiang D. Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Lumbar Disc Herniation: A Retrospective Cohort Study. Medical Science Monitor. 2018; 24: 8693–8698.

Piccioni F, Segat M, Falini S, Umari M, Putina O, Cavaliere L, et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. Journal of Thoracic Disease. 2018; 10: S555–S563.

Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block. Regional Anesthesia and Pain Medicine. 2016; 41: 621–627.

Aksu C, Gürkan Y. Ultrasound-guided bilateral erector spinae plane block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients. Anaesthesia Critical Care and Pain Medicine. 2019; 38: 87–88.

Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2021; 76: 404–413.

Zhang J, Feng X, Yang J, Wang Z, Wang Z, Bai L. Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block for perioperative analgesia in thoracoscopic pulmonary lobectomy: a randomized controlled trial. Insights into Imaging. 2022; 13: 16.

Pişkin Ö, Gökçe M, Altınsoy B, Baytar Ç, Aydın BG, Okyay RD, et al. Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study. General Thoracic and Cardiovascular Surgery. 2022; 70: 64–71.

Fu Z, Zhang Y, Zhou Y, Li Z, Wang K, Li H, et al. A comparison of paravertebral block, erector spinae plane block and the combination of erector spinae plane block and paravertebral block for post-operative analgesia after video-assisted thoracoscopic surgery: A randomised controlled trial. Journal of Minimal Access Surgery. 2022; 18: 241–247.

Liu L, Ni X, Zhang L, Zhao K, Xie H, Zhu J. Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial. Journal of Anesthesia. 2021; 35: 3–9.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Journal of Clinical Epidemiology. 2009; 62: 1006–1012.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996; 17: 1–12.

He B, Zhao JQ, Zhang MZ, Quan ZX. Zoledronic acid and fracture risk: a meta-analysis of 12 randomized controlled trials. European Review for Medical and Pharmacological Sciences. 2021; 25: 1564–1573.

Kjaergard LL, Villumsen J, Gluud C. Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-Analyses. Annals of Internal Medicine. 2001; 135: 982.

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002; 21: 1539–1558.

Yao Y, Fu S, Dai S, Yun J, Zeng M, Li H, et al. Impact of ultrasound-guided erector spinae plane block on postoperative quality of recovery in video-assisted thoracic surgery: a prospective, randomized, controlled trial. Journal of Clinical Anesthesia. 2020; 63: 109783.

Shim J, Ryu K, Kim PO, Cho E, Ahn J, Yeon J, et al. Evaluation of ultrasound-guided erector spinae plane block for postoperative management of video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial. Journal of Thoracic Disease. 2020; 12: 4174–4182.

Çiftçi B, Ekinci M, Çelik EC, Tukac IC, Gölboyu BE, Gunluoglu MZ, et al. Ultrasound-Guided Erector Spinae Plane Block and Thoracic Paravertebral Block for Postoperative Analgesia Management Following Video-Assisted Thoracic Surgery: a Prospective, Randomized, Controlled Study. Journal of Anesthesiology and Reanimation Specialists’ Society. 2020; 28: 170–178.

Ciftci B, Ekinci M, Celik EC, Tukac IC, Bayrak Y, Atalay YO. Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia Management after Video-Assisted Thoracic Surgery: a Prospective Randomized Study. Journal of Cardiothoracic and Vascular Anesthesia. 2020; 34: 444–449.

Bulgarelli Maqueda L, García-Pérez A, Minasyan A, Gonzalez-Rivas D. Uniportal VATS for non-small cell lung cancer. General Thoracic and Cardiovascular Surgery. 2020; 68: 707–715.

Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Kehlet H. Persistent postsurgical pain after video-assisted thoracic surgery - an observational study. Acta Anaesthesiologica Scandinavica. 2016; 60: 650–658.

Khoshbin E, Al-Jilaihawi AN, Scott NB, Prakash D, Kirk AJB. An Audit of Pain Control Pathways following Video-Assisted Thoracoscopic Surgery. Innovations. 2011; 6: 248–252.

Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: a systematic review. European Journal of Cardio-Thoracic Surgery. 2014; 45: 959–966.

Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Annals of Cardiac Anaesthesia. 2018; 21: 323–327.

Published

2023-10-30

How to Cite

Liu, L. ., Zhao, Y. ., Yongpeng He, Peng, W., He, H. ., & Liang, L. (2023). The Efficacy of Erector Spinae Plane Block for Thoracoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials. The Heart Surgery Forum, 26(5), E621-E627. https://doi.org/10.59958/hsf.5349

Issue

Section

Systematic Review