Park SM, Kim HS, Lim BG. Analgesic efficacy and safety of erector spinae plane block in pediatric patients undergoing elective surgery: A systematic review and Meta-analysis of randomized controlled trials.
J Clin Anesth 2024;
98:111575. [PMID:
39128258 DOI:
10.1016/j.jclinane.2024.111575]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/07/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
STUDY OBJECTIVE
Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.
DESIGN
Meta-analysis of randomized controlled trials.
SETTING
Perioperative setting.
PATIENTS
Pediatric patients undergoing elective surgery under general anesthesia.
INTERVENTIONS
We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and ClinicalTrials.gov databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.
MEASUREMENTS
The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.
MAIN RESULTS
The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = -1.51; 95% confidence interval, -2.39 to -0.64; P = 0.0002; I2 = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.
CONCLUSIONS
ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.
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