Data_Sheet_1_Efficacy of Erector Spinae Nerve Block for Pain Control After Spinal Surgeries: An Updated Systematic Review and Meta-Analysis.doc

BackgroundErector spinae plane block (ESPB), as a regional anesthesia modality, is gaining interest and has been used in abdominal, thoracic and breast surgeries. The evidence on the efficacy of this block in spinal surgeries is equivocal. Recently published reviews on this issue have concerning limitations in methodology.
MethodsA systematic search was conducted using the PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) that were done in patients undergoing spinal surgery and had compared outcomes of interest among those that received ESPB and those with no block/placebo were considered for inclusion. Statistical analysis was performed using STATA software. GRADE assessment was done for the quality of pooled evidence.
ResultsA total of 13 studies were included. Patients receiving ESPB had significantly reduced total opioid use (Standardized mean difference, SMD −2.76, 95% CI: −3.69, −1.82), need for rescue analgesia (Relative risk, RR 0.38, 95% CI: 0.22, 0.66) and amount of rescue analgesia (SMD −5.08, 95% CI: −7.95, −2.21). Patients receiving ESPB reported comparatively lesser pain score at 1 h (WMD −1.62, 95% CI: −2.55, −0.69), 6 h (WMD −1.10, 95% CI: −1.45, −0.75), 12 h (WMD −0.78, 95% CI: −1.23, −0.32) and 24 h (WMD −0.54, 95% CI: −0.83, −0.25) post-operatively. The risk of postoperative nausea and vomiting (PONV) (RR 0.32, 95% CI: 0.19, 0.54) was lower in those receiving ESPB. There were no differences in the duration of surgery, intra-operative blood loss and length of hospital stay between the two groups. The quality of pooled findings was judged to be low to moderate.
ConclusionsESPB may be effective in patients with spinal surgery in reducing post-operative pain as well as need for rescue analgesic and total opioid use. In view of the low to moderate quality of evidence, more trials are needed to confirm these findings.
Systematic Review Registration:http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021278133.

【背景】竖脊肌平面阻滞（Erector spinae plane block, ESPB）作为一种区域麻醉技术，正受到越来越多的关注，目前已被应用于腹部、胸科及乳腺手术中。但该阻滞技术在脊柱手术中的应用有效性相关证据仍不明确，且近期发表的相关综述在研究方法学上存在值得关注的局限性。
【方法】本研究通过PubMed、Scopus、Embase及Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials, CENTRAL）进行系统性文献检索。纳入标准为针对接受脊柱手术的患者、对比接受ESPB与未接受阻滞/安慰剂组受试者目标结局的随机对照试验（Randomized Controlled Trial, RCT）。统计分析采用STATA软件完成，对合并证据的质量采用GRADE分级进行评估。
【结果】最终共纳入13项研究。与对照组相比，接受ESPB的患者术后阿片类药物总使用量显著降低（标准化均数差SMD=-2.76，95%置信区间CI：-3.69~-1.82）、补救镇痛需求显著减少（相对危险度RR=0.38，95%CI：0.22~0.66）且补救镇痛药物使用量更低（SMD=-5.08，95%CI：-7.95~-2.21）。接受ESPB的患者在术后1小时（加权均数差WMD=-1.62，95%CI：-2.55~-0.69）、6小时（WMD=-1.10，95%CI：-1.45~-0.75）、12小时（WMD=-0.78，95%CI：-1.23~-0.32）及24小时（WMD=-0.54，95%CI：-0.83~-0.25）的疼痛评分均显著更低。接受ESPB的患者术后恶心呕吐（Postoperative Nausea and Vomiting, PONV）发生风险更低（RR=0.32，95%CI：0.19~0.54）。两组患者的手术时长、术中失血量及住院时长无显著差异。合并分析结果的证据质量被判定为低至中等水平。
【结论】ESPB或可有效降低脊柱手术患者的术后疼痛、补救镇痛需求及阿片类药物总使用量。鉴于当前证据质量为低至中等水平，仍需开展更多临床试验以验证上述结论。
【系统综述注册信息】注册平台：http://www.crd.york.ac.uk/PROSPERO/，注册号：CRD42021278133。