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Efficacy of Erector Spinae Plane Block in Pediatric Scoliosis Surgery: A Systematic Review and Meta-Analysis
Tejas Subramanian1,2, Michael Mazzucco1,2, Amrit Subramanian1
1Department of Orthopedic Surgery, Hospital for Special Surgery.
Study Design:
Systematic review and meta-analysis.
Objective:
To evaluate the impact of erector spinae plane (ESP) blocks on perioperative outcomes in pediatric scoliosis surgery.
Summary Of Background Data:
The ESP block is an increasingly utilized regional anesthesia technique in spine surgery, yet its efficacy in pediatric posterior spinal fusion for scoliosis correction remains incompletely characterized.
Methods:
A systematic database search was performed following PRISMA guidelines. Studies were included if they compared outcomes between pediatric patients receiving ESP blocks (ESP-B) and those undergoing standard care (control) undergoing posterior instrumented fusion. Data on postoperative pain scores, opioid consumption, time to PCA use, length of stay (LOS), and functional outcomes were extracted and synthesized using fixed-effects meta-analysis.
Results:
Six studies (4-level I, 2-level III) comprising 178 ESP-B patients and 197 controls were included. The ESP-B cohort had significantly lower postoperative pain scores at all assessed time points, including immediately postoperative (MD=-0.93, P=0.0035), 12 hours postoperative (MD=-2.15, P<0.001), and 48 hours postoperative (MD=-1.09, P<0.0001). In the ESP-B cohort, the time to PCA initiation was significantly delayed (MD=4.05 h, P<0.0001), total opioid consumption was lower (MD=-10.83 mg oral morphine equivalents, P<0.0001), and the incidence of postoperative nausea or vomiting was lower (OR=0.12, P=0.0008). The ESP-B cohort also had shorter postoperative LOS (MD=-1.34 d, P<0.0001). Though only reported in one study each, ESP-B experienced fewer opioid-related side effects, greater ambulation distances, and higher inpatient satisfaction scores.
Conclusion:
There is moderate evidence suggesting ESP blocks are effective in improving postoperative pain and reducing opioid requirements in pediatric patients undergoing posterior spinal fusion. These findings support the integration of ESP blocks into multimodal analgesia protocols for pediatric scoliosis correction.
