Erector Spinae Plane Block as an Analgesic Strategy for Hepatopancreaticobiliary Pain: A Systematic Review

Hepatopancreaticobiliary (HPB) pain is a common cause of emergency department (ED) and intensive care unit (ICU) presentation and is frequently managed with opioid analgesics. In the setting of the ongoing opioid crisis, effective non-opioid analgesic strategies are urgently needed. The erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique.

To systematically review and synthesize existing evidence on the feasibility, effectiveness, and safety of ESPB for HPB-related pain in acute care settings.

A systematic review was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched for studies reporting ESPB use in patients aged ≥16 years with HPB-related pain. Eligible studies included randomized trials, case series, case reports, and letters. Data on clinical setting, block technique, analgesic outcomes, and safety were extracted. Risk of bias was assessed using ROB 2 and Joanna Briggs Institute tools. Due to limited sample size and heterogeneity, results were synthesized qualitatively.

Thirteen studies were included, reporting outcomes in 55 patients within 1 hour and 64 patients within 24 hours. Most ESPBs were performed in the ED. Indications included pancreatitis, cholecystitis, and pancreatic malignancy. ESPB was associated with rapid pain reduction, often within 15-60 minutes, and reduced rescue opioid requirements. No block-related complications were reported.

Current case-based evidence suggests ESPB is a feasible, safe, and rapidly effective analgesic option for HPB-related pain in acute care settings, with potential opioid-sparing benefits. Higher-quality prospective studies are needed to confirm efficacy and standardize practice.