Erector spinae plane block for postoperative analgesia in vertebral surgery: An updated meta-analysis of randomized...

To evaluate the analgesic efficacy of the erector spinae plane (ESP) block in adults undergoing vertebral surgery and to determine whether the available evidence is sufficient to support definitive conclusions.

We conducted an updated systematic review and meta-analysis of randomized controlled trials (PROSPERO: CRD42025117873). The primary outcome was 24-h postoperative opioid consumption (morphine milligram equivalents [MME]). Secondary outcomes included pain scores at rest and during movement (0-48 h), rescue analgesia requirement, time to first rescue analgesic, time to mobilization, postoperative nausea and vomiting (PONV), hospital length of stay (LOS), quality of recovery, and chronic postsurgical pain. Random-effects models were used; publication bias was assessed with Egger's test when applicable. Risk of bias was assessed using RoB 2 and certainty using GRADE. Prespecified subgroup analyses, sensitivity analysis, meta-regression for the primary outcome, and trial sequential analysis (TSA) were performed.

Sixty trials (n = 4167, ESP block 2081, control 2086) were included. The ESP block was associated with a modest reduction in 24-h opioid consumption (MD -8.89 mg MME, 95% CI -11.44 to -6.33; p < 0.001, I² = 97.8%), accompanied by substantial unexplained heterogeneity. Early postoperative pain scores and rescue analgesic use favored the ESP block, while the most consistent effect was a reduced incidence of PONV (OR 0.40; I² = 0%). Evidence certainty was low for opioid and pain outcomes, moderate for rescue analgesia, and high for PONV. TSA indicated that the required sample size for opioid consumption was reached.

There is low-certainty evidence supporting a modest reduction in 24-h opioid consumption and early postoperative pain with ESP block in patients undergoing vertebral surgery. In contrast, high-certainty evidence supports a significant reduction in the incidence of PONV.