Erector Spinae Block in Bariatric Surgery: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Obesity is a growing global health issue, and bariatric surgery offers effective weight loss outcomes. Postoperative pain management remains a challenge, with multimodal analgesia and regional blocks like the erector spinae plane (ESPB) showing promise. This review aims to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) on key postoperative outcomes in bariatric surgery, specifically its impact on opioid consumption, pain management, and complication rates.

We conducted a systematic review and meta-analysis following PRISMA guidelines. In January 2025, we conducted a comprehensive search across PubMed, Embase, and Cochrane databases for studies comparing erector spinae block in bariatric surgery. Data extraction was standardized, focusing on postoperative analgesic consumption, pain control, intraoperative opioid consumption, respiratory complications and PONV. Statistical analysis was performed using RevMan 9.0.0, with random-effects models. Heterogeneity was assessed using Cochran's Q test and I² statistic.

The analysis included 9 randomized controlled trials (RCTs) with a total of 553 patients. ESP block significantly reduced total opioid consumption (MD -9.53, 95% CI -15.10 to -3.96, p = 0.0008), pain scores like NRS (MD -1.15, 95% CI -1.76 to -0.55, p = 0.0002). Despite heterogeneity across studies, ESPB was associated with reduced opioid use and better pain control. ESP block was associated with a significant reduction in VAS pain scores during the first 12 h after surgery, although substantial heterogeneity was observed across studies. Using the ESP block significantly reduced the incidence of postoperative nausea and vomiting, with consistent results across studies (I² = 0%). There was no significant difference in the incidence of respiratory complications between the study groups.

ESPB is associated with significant reductions in postoperative pain scores and total opioid consumption, while no significant difference in respiratory complications was observed between the groups.