scholarly journals Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Zhang ◽  
Tieshuai Liu ◽  
Youfa Zhou ◽  
Yijin Yu ◽  
Gang Chen
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Cancer Surgery ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Breast Cancer Surgery ◽  
Rescue Analgesia ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery. Methods We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV). Results Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of − 7.67 mg [95% confidence interval (CI) − 10.35 to − 5.00] (P <  0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV. Conclusions Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

scholarly journals Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery

2020 ◽  
Vol 46 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Nasir Hussain ◽  
Richard Brull ◽  
Jordan Noble ◽  
Tristan Weaver ◽  
Michael Essandoh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Oral Morphine ◽  
Cancer Surgery ◽  
Erector Spinae ◽  
Breast Cancer Surgery ◽  
Short Term ◽  
Erector Spinae Plane Block ◽  
Quality Evidence

The novel erector spinae plane block (ESPB) has been reported to provide important postoperative analgesic benefits following a variety of truncal and abdominal surgical procedures. However, evidence of its analgesic efficacy following breast cancer surgery, compared with parenteral analgesia, is unclear. This meta-analysis evaluates the analgesic benefits of adding ESPB to parenteral analgesia following breast cancer surgery.Databases were searched for breast tumor resection trials comparing ESPB to parenteral analgesia. The two co-primary outcomes examined were 24-hour postoperative oral morphine equivalent consumption and area-under-curve of rest pain scores. We considered reductions equivalent to 3.3 cm.h and 30 mg oral morphine in the first 24 hours postoperatively for the two co-primary outcomes, respectively, to be clinically important. We also assessed opioid-related side effects and long-term outcomes, including health-related quality of life, persistent postsurgical pain and opioid dependence. Results were pooled using random effects modeling.Twelve trials (699 patients) were analyzed. Moderate quality evidence suggested that ESPB decreased 24-hour morphine consumption and area-under-curve of rest pain by a mean difference (95% CI) of −17.60 mg (−24.27 to −10.93) and -2.74 cm.h (−3.09 to −2.39), respectively; but these differences were not clinically important. High-quality evidence suggested that ESPB decreased opioid-related side effects compared with parenteral analgesia by an OR (95% CI) of 0.43 (0.28 to 0.66). None of the studies evaluated long-term block benefits.Adding ESPB to parenteral analgesia provides statistically significant but clinically unimportant short-term benefits following breast cancer surgery. Current evidence does not support routine use of ESPB. Given the very modest short-term benefits and risk of complications, the block should be considered on a case-by-case basis.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia ( RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV).Conclusions: Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.Results A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia (RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV). Conclusions Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256611
Author(s):  
Chang Xiong ◽  
Chengpeng Han ◽  
Dong Zhao ◽  
Wenyong Peng ◽  
Duojia Xu ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Breast Surgery ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Analgesic Effects ◽  
Erector Spinae Plane Block ◽  
Pain Scores ◽  
Post Operation ◽  
Time Required

Background Paravertebral block (PVB) is the most recognized regional anesthesia technique after thoracic epidural anesthesia for postoperative analgesia in thoracic and breast surgery. Erector spinae plane block (ESPB) is a recently discovered blocking technique, and it has evidenced excellent postoperative analgesia for breast and thoracic surgery with fewer adverse reactions. However, there are controversies about the postoperative analgesic effects of the two analgesic techniques. Objective To assess the analgesic effects of PVB versus ESPB in postoperative thoracic and breast surgery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up to April 5, 2021. The primary outcome was postoperative pain scores. Secondary outcomes included: opioid consumption, additional analgesia, postoperative nausea and vomiting (PONV) 24 hours post-operation, and the time required for completing block procedure. This study was registered in PROSPERO, number CRD42021246160. Results After screening relevant, full-text articles, ten randomized controlled trials (RCTs) that met the inclusion criteria were retrieved for this meta-analysis. Six studies involved thoracic surgery patients, and four included breast surgery patients. Thoracic surgery studies included all of the outcomes involved in this meta-analysis while breast surgery did not report pain scores at movement and additional analgesia in 24 hours post-operation. For thoracic surgery, PVB resulted in significant reduction in the following pain scores: 0–1 hours (MD = -0.79, 95% CI: -1.54 to -0.03, P = 0.04), 4–6 hours (MD = -0.31, 95% CI: -0.57 to -0.05, P = 0.02), and 24 hours (MD = -0.42, 95% CI: -0.81 to -0.02, P = 0.04) at rest; significant reduction in pain scores at 4–6 hours (MD = -0.47, 95% CI: -0.93 to -0.01, P = 0.04), 8–12 hours (MD = -1.09, 95% CI: -2.13 to -0.04, P = 0.04), and 24 hours (MD = -0.31, 95% CI: -0.57 to -0.06, P = 0.01) at movement. Moreover, the opioid consumption at 24 hours post-operation (MD = -2.74, 95% CI: -5.41 to -0.07, P = 0.04) and the incidence of additional analgesia in 24 hours of the postoperative course (RR: 0.53, 95% CI: 0.29 to 0.97, P = 0.04) were significantly lower in the PVB group than in the ESPB group for thoracic surgery. However, no significant differences were found in pain scores at rest at various time points postoperatively, and opioid consumption at 24 hours post-operation for breast surgery. The time required for completing block procedure was longer in the PVB group than in the ESPB group for thoracic and breast surgery, and the incidence of PONV between the two groups showed no significant difference. Conclusion The postoperative analgesic effects of PVB versus ESPB are distinguished by the surgical site. For thoracic surgery, the postoperative analgesic effect of PVB is better than that of ESPB. For breast surgery, the postoperative analgesic effects of PVB and ESPB are similar.

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