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Efficacy of Erector Spinae Plane Block in Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis on
Jingjing Ye1, Jie Wu1, Yi Zhou1
1Department of Orthopedics, Key Laboratory of Orthopedics of Zhejiang Province, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
Purpose:
Lumbar fusion surgery is commonly associated with severe postoperative pain and high opioid requirements. The erector spinae plane block (ESPB) has demonstrated promising analgesic effects in spine procedures; however, its efficacy specifically in lumbar fusion surgery remains uncertain, given the heterogeneity of the existing evidence. This systematic review and meta-analysis aimed to evaluate the impact of ESPB on perioperative opioid consumption, postoperative pain, and related outcomes in patients undergoing lumbar fusion surgery.
Patients And Methods:
Following the PRISMA 2020 statement, PubMed, Embase, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials (RCTs) comparing ESPB with placebo, sham, or no-block controls in adult patients undergoing lumbar fusion. The primary outcomes were intraoperative and 24-hour postoperative opioid consumption, expressed as intravenous morphine milligram equivalents (MME). Secondary outcomes included postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and certainty of evidence was graded using GRADE criteria.
Results:
Fifteen RCTs involving 1035 patients were included. ESPB significantly reduced intraoperative opioid use (MD -31.70 mg; 95% CI -41.69 to -21.71) and 24-hour postoperative opioid consumption (MD -11.02 mg; 95% CI -14.42 to -7.63), as well as resting pain scores (MD -0.49; 95% CI -0.77 to -0.22). ESPB was also associated with a lower risk of PONV (RR 0.71; 95% CI 0.53-0.94). Considerable heterogeneity (I2 >80%) was observed, largely attributable to variations in study design, comparator rigor, and blinding quality.
Conclusion:
Low- to moderate-certainty evidence suggests that ESPB probably reduces perioperative opioid consumption, early postoperative pain, and opioid-related adverse events such as PONV following lumbar fusion surgery. Although substantial heterogeneity and variability in methodological quality warrant cautious interpretation, the consistent direction and clinical relevance of observed effects support ESPB as a promising adjunct within multimodal analgesia pathways. Further well-designed, blinded RCTs with standardized protocols and extended follow-up are needed to confirm long-term effectiveness and refine clinical implementation.
