Impact of erector spinae plane block on postoperative recovery quality in spinal surgery: a systematic review and meta-analysis

Postoperative recovery quality (QoR) is a key indicator for evaluating the restoration of patients’ functional status and overall quality of life post-surgery. Moreover, it is an essential metric for assessing the effectiveness of patient-centered anesthetic care. The erector spinae plane block (ESPB) is an innovative regional analgesia technique that has garnered considerable attention for its potential use in spinal surgeries. Although some studies suggest that ESPB may improve QoR, the results remain contentious and inconclusive. This meta-analysis aims to systematically evaluate the effects of ESPB on the subjective quality of recovery in patients undergoing spinal surgery, with the objective of providing more robust evidence to support its clinical application.

On September 23, 2024, we conducted a systematic search across the PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases to identify randomized controlled trials (RCTs) relevant to ESPB. The studies evaluated the effect of ESPB compared to conventional analgesia on QoR in patients undergoing spinal surgery. The primary outcome measure of this study was postoperative the 24-hour QoR score, as assessed by validated QoR scales (QoR-15 and QoR-40). Secondary outcome measures included the QoR score at 48 h postoperatively, the incidence of postoperative nausea and vomiting (PONV), and the consumption of opioid analgesics in the first 24 h postoperatively.

This meta-analysis included eight studies, with a total of 578 patients. The results demonstrated that, compared to the control group, the ESPB group showed improvements in overall QoR-15 scores (mean difference [MD]: 9.76; 95% confidence interval [CI]: 8.39–11.13; P < 0.01; I² = 0%) and QoR-40 scores (MD: 11.8; 95% CI: 6.35–17.25; P = 0.000), indicating clinically meaningful benefits. Additionally, although the QoR-15 (MD: 3.69; 95% CI: 2.60–4.78; P < 0.01; I² = 2.31%) and QoR-40 scores (MD: 5.70; 95% CI: 0.11–11.29; P = 0.046) at 48 h postoperatively demonstrated a statistical improvement, the magnitude of this change did not reach the threshold for clinical relevance. Moreover, ESPB reduced the incidence of PONV (log odds ratio [log(OR)]: -0.63; 95% CI: -1.11–-0.14; P = 0.01; I² = 24.62%) and the 24-hour postoperative opioid consumption(SMD: -0.56; 95% CI: -0.83–-0.29; P < 0.01; I² = 0%).

ESPB was associated with an improvement in the quality of recovery within the first 24 h postoperatively in patients undergoing spinal surgery, along with a reduction in the incidence of PONV and opioid consumption. However, while the improvement in recovery quality at 48 h postoperatively was statistically significant, its clinical significance was limited. These findings suggest that ESPB may be a beneficial adjunct for enhancing postoperative recovery, but further studies are needed to validate its long-term impact and clinical applicability.