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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims ERAS Society recommends intrathecal opiates and continuous local anaesthetic wound infusion for post-operative analgesia following liver resection. However, patients with contraindications to central neuraxial block may receive suboptimal analgesia. Emerging evidence suggests that erector spinae plane block (ESPB) may be a promising alternative, but a systematic review has not been available thus far. This systematic review and meta-analysis aims to compare the analgesic efficacy and safety of single or continuous ESPB with any other peripheral regional anaesthetic (RA) technique or with no block in adults for liver resection under general anaesthesia.
Methods This review was undertaken according to a prospectively registered protocol on PROSPERO website under the registration number CRD42023445867. It follows the guidance on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search included PubMed, Embase, Web of Science Citation Index, Europe PMC and Cochrane Central Register of Controlled Trials until 17th July 2023. The primary outcomes of this review were 24-hour postoperative pain score at rest and ESPB-related complications.
Results Eleven randomized controlled trials with a total of 629 participants were included in the systematic review and meta-analysis. At 24-hour after liver resection, ESPB provided better analgesia compared to no block or other peripheral regional block, while analgesic effect was inferior to intrathecal morphine (ITM). ESPB reduced opioid consumption and its related complications. No ESPB procedure-related complications were reported.
Risk of bias summary
24-hour postoperative pain score at rest
Subgroup and sensitivity analysis
Conclusions ESPB provides effective pain control after liver resection where ITM is not an option. It has a high safety margin and reduces opioid-related complications.