Erector spinae plane block for postoperative analgesia in vertebral surgery: An updated meta-analysis of randomized controlled trials with trial sequential analysis and meta-regression

Dost B., Turunç E., Karapinar Y. E., Beldagli M., Turan E. I., Dokmeci H., ...More

JOURNAL OF CLINICAL ANESTHESIA, vol.111, 2026 (SCI-Expanded, Scopus) identifier identifier identifier

Abstract

Objectives: 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. Methods: 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. Results: 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, I-2 = 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; I-2 = 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. Conclusions: 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.