Ultrasound-guided erector spinae plane block for perioperative analgesia in laparoscopic nephrectomy: A systematic...

Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times. However, effective management of postoperative pain remains a significant challenge. Several traditional methods, including opioid-based analgesia, are commonly used but are associated with side effects such as nausea, vomiting, sedation, and delayed recovery. In recent years, the erector spinae plane block (ESPB) has gained attention as an ultrasound-guided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.

To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.

Following PRISMA guidelines, we searched PubMed, EMBASE, Web of Science, and the Cochrane Register for randomized controlled trials (RCTs) comparing ESPB with control for laparoscopic nephrectomy. The Cochrane Risk of Bias tool was employed for quality assessment. The primary outcome was total patient-controlled analgesia (PCA) consumption. Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting. A random-effects meta-analysis was conducted to calculate pooled mean differences (MD) and odds ratios (OR) with 95%CIs.

Nine RCTs involving a total of 643 patients (ESPB group = 320; control group = 323) were included in the analysis. ESPB significantly reduced PCA opioid consumption compared to controls (MD: -14.24, 95%CI: -20.66 to -7.83, P < 0.0001). Subgroup analysis showed reduced PCA use with ESPB vs morphine (MD: -8.78, 95%CI: -15.34 to -2.22, P = 0.009), and a non-significant effect compared to other analgesics (MD: -48.26, 95%CI: -143.60 to 47.09). No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.

ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients; however, its impact on secondary outcomes remains inconclusive. Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.