Safety and efficacy of erector spinae plane block for perioperative analgesia in posterior spinal fusion surgery for pediatric idiopathic scoliosis: a meta-analysis

Abstract

Background
Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with severe postoperative pain leading to prolonged hospital stay and increased analgesic requirements. This meta-analysis aims to evaluate the efficacy of the erector spinae plane block (ESPB) in reducing postoperative pain and opioid consumption in AIS patients undergoing PSF.

Methods
A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The following databases were searched: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL).

Results
Five studies involving a total of 352 patients were included, with 167 in the ESPB group and 185 in the control group. ESPB significantly reduced postoperative pain scores during the initial 24 postoperative hours (SMD = −1.58; CI −2.98 to −0.18; P = 0.03). Opioid consumption was significantly lower both intraoperatively (SMD = −3.72; CI −5.91 to −1.53; P = 0.0009) and postoperatively (SMD = −3.22; CI −5.14 to −1.30; P = 0.001). Rescue analgesia was required less frequently in the ESPB group (OR = 0.15; CI 0.08 to 0.29; P < 0.00001), and the time to first rescue analgesia was significantly longer (SMD = 2.95; CI 0.61 to 5.28; P = 0.01). Secondary outcomes, including incidence of opioid-related side effects, time to ambulation, length of hospital stay, and percentage change in motor-evoked potentials, were comparable between the ESPB and control groups.

Conclusion
Our findings suggest that the erector spinae plane block (ESPB) in PSF for AIS is effective in reducing postoperative pain up to 24 h postoperatively and results in lower overall opioid consumption without a significant increase in complications.