Skip to main content
Top

31-01-2025 | Opioids | Review

Efficacy of Erector Spinae Plane Block on Analgesic Outcomes in Patients Undergoing Metabolic Surgery: A Meta-Analysis of Randomized Controlled Trials

Authors: Kuo-Chuan Hung, Wei-Cheng Liu, Chih-Wei Hsu, Jheng-Yan Wu, Shu-Wei Liao, I-Wen Chen

Published in: Obesity Surgery

Login to get access

Abstract

This meta-analysis evaluated the analgesic efficacy of erector spinae plane block (ESPB) in metabolic surgery through analysis of ten randomized controlled trials (786 patients). ESPB demonstrated superior pain control compared to placebo from 2–12 h postoperatively, with peak effect at 6 h and sustained movement-related pain reduction through 24 h. ESPB showed comparable analgesic efficacy to other nerve blocks within 24 h postoperatively. The technique significantly reduced intraoperative and postoperative opioid consumption, extended time to first analgesic requirement, and decreased rescue analgesia needs. Additionally, ESPB recipients experienced reduced postoperative nausea and vomiting and shorter hospital stays. These findings support ESPB as an effective component of multimodal analgesia protocols for metabolic surgery, though standardization of techniques and long-term outcome studies are needed.
Appendix
Available only for authorised users
Literature
1.
go back to reference Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;133:155217.CrossRefPubMedPubMedCentral Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;133:155217.CrossRefPubMedPubMedCentral
2.
go back to reference Madar LO, Goldberg N, Netz U, et al. Association between metabolic and bariatric surgery and malignancy: a systematic review, meta-analysis, trends, and conclusions. Surg Obes Relat Dis. 2024. Madar LO, Goldberg N, Netz U, et al. Association between metabolic and bariatric surgery and malignancy: a systematic review, meta-analysis, trends, and conclusions. Surg Obes Relat Dis. 2024.
3.
go back to reference Tao W, Santoni G, von Euler-Chelpin M, et al. Cancer risk after bariatric surgery in a cohort study from the five nordic countries. Obes Surg. 2020;30:3761–7.CrossRefPubMedPubMedCentral Tao W, Santoni G, von Euler-Chelpin M, et al. Cancer risk after bariatric surgery in a cohort study from the five nordic countries. Obes Surg. 2020;30:3761–7.CrossRefPubMedPubMedCentral
4.
go back to reference Zhu C, Liu W, Hu D. Risk of esophageal adenocarcinoma after bariatric surgery: a meta-analysis of retrospective studies. Obes Surg. 2024;34:1726–36.CrossRefPubMed Zhu C, Liu W, Hu D. Risk of esophageal adenocarcinoma after bariatric surgery: a meta-analysis of retrospective studies. Obes Surg. 2024;34:1726–36.CrossRefPubMed
5.
go back to reference Sonaiya S, Zevallos A, Adrales G. Long-term cardiovascular disease outcomes following bariatric surgery. J Surg Res. 2024;304:225–31.CrossRefPubMed Sonaiya S, Zevallos A, Adrales G. Long-term cardiovascular disease outcomes following bariatric surgery. J Surg Res. 2024;304:225–31.CrossRefPubMed
6.
go back to reference Huang H, Lu J, Dai X, et al. Improvement of renal function after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2021;31:4470–84.CrossRefPubMed Huang H, Lu J, Dai X, et al. Improvement of renal function after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2021;31:4470–84.CrossRefPubMed
7.
go back to reference Garcia MM, Corrales P, Huerta M, et al. Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1340465.CrossRefPubMed Garcia MM, Corrales P, Huerta M, et al. Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1340465.CrossRefPubMed
8.
9.
go back to reference Rivas E, Cohen B, Pu X, et al. Pain and opioid consumption and mobilization after surgery: post hoc analysis of two randomized trials. Anesthesiology. 2022;136:115–26.CrossRefPubMed Rivas E, Cohen B, Pu X, et al. Pain and opioid consumption and mobilization after surgery: post hoc analysis of two randomized trials. Anesthesiology. 2022;136:115–26.CrossRefPubMed
10.
go back to reference Ahmed J, Lim M, Khan S. Predictors of length of stay in patients having elective colorectal surgery within an enhanced recovery protocol. Int J Surg. 2010;8:628–32.CrossRefPubMed Ahmed J, Lim M, Khan S. Predictors of length of stay in patients having elective colorectal surgery within an enhanced recovery protocol. Int J Surg. 2010;8:628–32.CrossRefPubMed
11.
go back to reference Lloret-Linares C, Lopes A, Declèves X, et al. Challenges in the optimisation of post-operative pain management with opioids in obese patients: a literature review. Obes Surg. 2013;23:1458–75.CrossRefPubMed Lloret-Linares C, Lopes A, Declèves X, et al. Challenges in the optimisation of post-operative pain management with opioids in obese patients: a literature review. Obes Surg. 2013;23:1458–75.CrossRefPubMed
12.
go back to reference Chung F, Memtsoudis SG, Ramachandran SK, et al. Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg. 2016;123:452–73.CrossRefPubMedPubMedCentral Chung F, Memtsoudis SG, Ramachandran SK, et al. Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg. 2016;123:452–73.CrossRefPubMedPubMedCentral
13.
go back to reference Dong Z, Xu X, Wang C, et al. Association of overweight and obesity with obstructive sleep apnoea: a systematic review and meta-analysis. Obesity Medicine. 2020;17:100185.CrossRef Dong Z, Xu X, Wang C, et al. Association of overweight and obesity with obstructive sleep apnoea: a systematic review and meta-analysis. Obesity Medicine. 2020;17:100185.CrossRef
14.
go back to reference Hung K-C, Wu S-C, Chang P-C, et al. Impact of intraoperative ketamine on postoperative analgesic requirement following bariatric surgery: a meta-analysis of randomized controlled trials. Obes Surg. 2021;31:5446–57.CrossRefPubMed Hung K-C, Wu S-C, Chang P-C, et al. Impact of intraoperative ketamine on postoperative analgesic requirement following bariatric surgery: a meta-analysis of randomized controlled trials. Obes Surg. 2021;31:5446–57.CrossRefPubMed
15.
go back to reference Hung K-C, Wu S-C, Chiang M-H, et al. Analgesic efficacy of gabapentin and pregabalin in patients undergoing laparoscopic bariatric surgeries: A systematic review and meta-analysis. Obes Surg. 2022;32:2734–43.CrossRefPubMed Hung K-C, Wu S-C, Chiang M-H, et al. Analgesic efficacy of gabapentin and pregabalin in patients undergoing laparoscopic bariatric surgeries: A systematic review and meta-analysis. Obes Surg. 2022;32:2734–43.CrossRefPubMed
16.
go back to reference Hung K-C, Chang Y-J, Chen I-W, et al. Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies. Surg Obes Relat Dis. 2022;18:135–47.CrossRefPubMed Hung K-C, Chang Y-J, Chen I-W, et al. Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies. Surg Obes Relat Dis. 2022;18:135–47.CrossRefPubMed
17.
go back to reference Zhang Y, Zhou Y, Hu T, et al. Dexmedetomidine reduces postoperative pain and speeds recovery after bariatric surgery: a meta-analysis of randomized controlled trials. Surg Obes Relat Dis. 2022;18:846–53.CrossRefPubMed Zhang Y, Zhou Y, Hu T, et al. Dexmedetomidine reduces postoperative pain and speeds recovery after bariatric surgery: a meta-analysis of randomized controlled trials. Surg Obes Relat Dis. 2022;18:846–53.CrossRefPubMed
18.
go back to reference Uludag Yanaral T, Gungor H, Ince A, et al. Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study. Minerva Anestesiol. 2024;90:1082–9.PubMed Uludag Yanaral T, Gungor H, Ince A, et al. Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study. Minerva Anestesiol. 2024;90:1082–9.PubMed
19.
go back to reference Greene JJ, Chao S, Tsui BCH. Clinical Outcomes of Erector Spinae Plane Block for Midline Sternotomy in Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2024;38:964–73.CrossRefPubMed Greene JJ, Chao S, Tsui BCH. Clinical Outcomes of Erector Spinae Plane Block for Midline Sternotomy in Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2024;38:964–73.CrossRefPubMed
20.
go back to reference Bang YJ, Lee EK, Jeong H, et al. Analgesic efficacy of erector spinae plane block in patients undergoing major gynecologic surgery: A randomized controlled study. J Clin Anesth. 2024;93:111362.CrossRefPubMed Bang YJ, Lee EK, Jeong H, et al. Analgesic efficacy of erector spinae plane block in patients undergoing major gynecologic surgery: A randomized controlled study. J Clin Anesth. 2024;93:111362.CrossRefPubMed
21.
go back to reference Fu MY, Hao J, Ye LH, et al. Efficacy and safety of erector spinae plane block for perioperative pain management in lumbar spinal surgery: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2023;16:1453–75.CrossRefPubMedPubMedCentral Fu MY, Hao J, Ye LH, et al. Efficacy and safety of erector spinae plane block for perioperative pain management in lumbar spinal surgery: a systematic review and meta-analysis of randomized controlled trials. J Pain Res. 2023;16:1453–75.CrossRefPubMedPubMedCentral
22.
go back to reference Forero M, Rajarathinam M, Adhikary S, et al. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series. Scand J Pain. 2017;17:325–9.CrossRefPubMed Forero M, Rajarathinam M, Adhikary S, et al. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series. Scand J Pain. 2017;17:325–9.CrossRefPubMed
23.
go back to reference Daghmouri MA, Akremi S, Chaouch MA, et al. Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2021;21:357–65.CrossRefPubMed Daghmouri MA, Akremi S, Chaouch MA, et al. Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2021;21:357–65.CrossRefPubMed
24.
go back to reference Gao Y, Liu L, Cui Y, et al. Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials. Front Med (Lausanne). 2022;9:934866.CrossRefPubMed Gao Y, Liu L, Cui Y, et al. Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials. Front Med (Lausanne). 2022;9:934866.CrossRefPubMed
25.
go back to reference Oraee S, Rajai Firouzabadi S, Mohammadi I, et al. Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis. BMC Anesthesiol. 2024;24:389.CrossRefPubMedPubMedCentral Oraee S, Rajai Firouzabadi S, Mohammadi I, et al. Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis. BMC Anesthesiol. 2024;24:389.CrossRefPubMedPubMedCentral
26.
go back to reference Nair AS, Rangaiah M, Dudhedia U, et al. Analgesic efficacy and outcomes of ultrasound-guided erector spinae plane block in patients undergoing bariatric and metabolic surgeries: a systematic review. J Med Ultrasound. 2023;31:178–87.CrossRefPubMedPubMedCentral Nair AS, Rangaiah M, Dudhedia U, et al. Analgesic efficacy and outcomes of ultrasound-guided erector spinae plane block in patients undergoing bariatric and metabolic surgeries: a systematic review. J Med Ultrasound. 2023;31:178–87.CrossRefPubMedPubMedCentral
27.
go back to reference Abdelhamid BM, Khaled D, Mansour MA, et al. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol. 2020;86:816–26.CrossRefPubMed Abdelhamid BM, Khaled D, Mansour MA, et al. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol. 2020;86:816–26.CrossRefPubMed
28.
go back to reference Ashoor TM, Jalal AS, Said AM, et al. Ultrasound-guided techniques for postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy: Erector Spinae Plane block vs. Quadratus Lumborum Block. Pain Phys. 2023;26:245–56.CrossRef Ashoor TM, Jalal AS, Said AM, et al. Ultrasound-guided techniques for postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy: Erector Spinae Plane block vs. Quadratus Lumborum Block. Pain Phys. 2023;26:245–56.CrossRef
29.
go back to reference Elshazly M, El-Halafawy YM, Mohamed DZ, et al. Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial. Korean J Anesthesiol. 2022;75:502–9.PubMedPubMedCentral Elshazly M, El-Halafawy YM, Mohamed DZ, et al. Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial. Korean J Anesthesiol. 2022;75:502–9.PubMedPubMedCentral
30.
go back to reference Jinaworn P, Pannangpetch P, Bunanantanasan K, et al. Efficacy of erector spinae plane block on postoperative analgesia for patients undergoing metabolic bariatric surgery: a randomized controlled trial. Obes Surg. 2024;34:4211–9.CrossRefPubMed Jinaworn P, Pannangpetch P, Bunanantanasan K, et al. Efficacy of erector spinae plane block on postoperative analgesia for patients undergoing metabolic bariatric surgery: a randomized controlled trial. Obes Surg. 2024;34:4211–9.CrossRefPubMed
31.
go back to reference Karaveli A, Kaplan S, Kavakli AS, et al. The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study. Obes Surg. 2024;35:112–21.CrossRefPubMed Karaveli A, Kaplan S, Kavakli AS, et al. The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study. Obes Surg. 2024;35:112–21.CrossRefPubMed
32.
go back to reference Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound-guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery: a prospective randomized controlled trial. Pain Pract. 2021;21:445–53.CrossRefPubMed Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound-guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery: a prospective randomized controlled trial. Pain Pract. 2021;21:445–53.CrossRefPubMed
33.
go back to reference Toprak H, Başaran B, Toprak ŞS, et al. Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery: a randomized controlled trial. Obes Surg. 2023;33:2640–51.CrossRefPubMed Toprak H, Başaran B, Toprak ŞS, et al. Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery: a randomized controlled trial. Obes Surg. 2023;33:2640–51.CrossRefPubMed
34.
go back to reference Tang X, Wang Y, Dong W. Effect of esketamine on early cognitive function of elderly patients after hip surgery. J Int Psychiatry. 2023;50:820–2. Tang X, Wang Y, Dong W. Effect of esketamine on early cognitive function of elderly patients after hip surgery. J Int Psychiatry. 2023;50:820–2.
35.
go back to reference Yang G, Wang P, Yin Y, et al. Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. PeerJ. 2024;12:e17431.CrossRefPubMedPubMedCentral Yang G, Wang P, Yin Y, et al. Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. PeerJ. 2024;12:e17431.CrossRefPubMedPubMedCentral
36.
go back to reference Zengin SU, Ergun MO, Gunal O. Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Pain and Intraoperative Opioid Consumption in Bariatric Surgery. Obes Surg. 2021;31:5176–82.CrossRefPubMed Zengin SU, Ergun MO, Gunal O. Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Pain and Intraoperative Opioid Consumption in Bariatric Surgery. Obes Surg. 2021;31:5176–82.CrossRefPubMed
37.
go back to reference Curatolo M. Central sensitization and pain: pathophysiologic and clinical insights. Curr Neuropharmacol. 2024;22:15–22.CrossRefPubMed Curatolo M. Central sensitization and pain: pathophysiologic and clinical insights. Curr Neuropharmacol. 2024;22:15–22.CrossRefPubMed
38.
go back to reference Zhu J, Wu L, Chen G, et al. Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgery: a propensity score matching analysis. Obes Surg. 2022;32:819–28.CrossRefPubMed Zhu J, Wu L, Chen G, et al. Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgery: a propensity score matching analysis. Obes Surg. 2022;32:819–28.CrossRefPubMed
39.
go back to reference Ding X, Chen D, Che J, et al. Penehyclidine hydrochloride for treating postoperative nausea and vomiting after laparoscopic bariatric surgery: a double-blinded randomized controlled trial. BMC Anesthesiol. 2023;23:135.CrossRefPubMedPubMedCentral Ding X, Chen D, Che J, et al. Penehyclidine hydrochloride for treating postoperative nausea and vomiting after laparoscopic bariatric surgery: a double-blinded randomized controlled trial. BMC Anesthesiol. 2023;23:135.CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy of Erector Spinae Plane Block on Analgesic Outcomes in Patients Undergoing Metabolic Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors
Kuo-Chuan Hung
Wei-Cheng Liu
Chih-Wei Hsu
Jheng-Yan Wu
Shu-Wei Liao
I-Wen Chen
Publication date
31-01-2025
Publisher
Springer US
Published in
Obesity Surgery
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-025-07724-9
SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

  • Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now