Table 2. Prospective studies evaluation opioid consumption with erector spinae blocks.
| Article | Type of study | #Subjects | Groups | Anesthesia used per phase | Opioid consumption | Patient reported pain | Patient satisfaction (talk about scale) | LOS/PLOS | Postoperative complications | Adjuvants used |
|---|---|---|---|---|---|---|---|---|---|---|
| Singh et al., 2019 (32) | RCT | 40 | Control; ESPB group received bilateral 20 mL of 0.5% bupivacaine | Induction: propofol + morphine; intubation: vecuronium; maintenance: isoflurane + nitrous oxide + oxygen | The cumulative morphine requirement in the 24 h after surgery was significantly lower in the ESP block compared with that in the control group (1.4±1.5 vs. 7.2±2.0 mg; P<0.001) | Numerica Rating Scale Pain scores immediately after surgery (P=0.001), 6 h (P=0.002), and 8 h (P=0.001) after surgery significantly different between control and ESP group | Patients in the ESP block group were more satisfied than those in the control group; the mean satisfaction scores were 5.5 (0.74) and 7.7 (0.45) in the control and ESP block groups, respectively (P<0.0001) | N/A | 2 patients in the control group developed nausea and vomiting; 0 patient in the ESP group had any post-operative complications |
Fentanyl used in intraoperative analgesia |
| Asar et al., 2021 (33) | RCT | 78 | Control; ESPB group received bilateral 10 mL 0.5% bupivacaine + 5 mL of 2% lidocaine, + 5 mL of 0.9% NaCl | Induction: propofol + fentanyl + rocuronium; maintenance: sevoflurane + oxygen | Opioid (paracetamol) consumption (P=0.0003), PCA button pressing number (P=0.000), Rescue diclofenac (P=0.043), Meperidine requirement in PACU (P=0.046), and Total morphine consumption (P=0.000) all statistically significant lower in ESPB | Numerical Rating Scale numbers statistically significant at 6 (P=0.000), 12 (P=0.000), and 24 h post-operation (P=0.007) | N/A | N/A | Not statistically significant | Tramodol + paracetamol IV were applied to both groups 30 min before the end of surgery; remifentanil used in Intraoperative analgesia; control group received sugammadex at end of surgery |
| Nashibi et al., 2022 (34) |
RCT | 40 | Control; ESPB group received bilateral 20 mL of 0.25% bupivacaine | Induction: propofol, atracurium, and lidocaine; maintenance: propofol + atracurium | Meperidine consumption was 57.50±45.95 mg in control group and 22.50±32.34 in ESP block which was statistically higher in control group (P=0.01) |
Numerical Rating Scale Pain scores statistically significant at all times (1, 2, 4, 6, 12, 24 h post-operation) | N/A | N/A | Not statistically significant | Premedication: midazolam + fentanyl for all patients; IV morphine at beginning of surgery for both groups; IV paracetamol at end of surgery for both groups |
| Vergari et al., 2022 (35) | RCT | 60 | Control; ESPB group received bilateral 40 mL of 0.375% ropivacaine | Induction: propofol + sufentanil; intubation: rocuronium; maintenance: propofol + sufentanil | Total sufentanil tablets consumption of 17±6 and 10±3 mg at 48 h for control group and ESPB group, respectively (P<0.001) | Numerical Rating Scale Pain values statistically significant: 1.9±1.5 in ESPB group and 5.9±1.6 in control group (P<0.001) | N/A | Statistically significant: 30 (100%) patients in the control group and 22 (73.3%) in ESPB group were discharged after 72 hours (P=0.005) | No complications in either group | NR |
| Finnerty et al., 2021 (20) |
RCT | 60 | Control; ESPB group received bilateral 40 mL levobupivacaine 0.25% | Induction: propofol + fentanyl; intubation: neuromuscular blockade; maintenance: sevoflurane + oxygen | The cumulative mean oxycodone consumption to 24 h was 27±18 mg in the control group and 19±26 mg after block, P=0.20; not statistically significant | Mean pain at 12 h postoperative was greater in control participants than block participants: at rest, 3.5±2.6 vs. 2.1±1.9, P=0.021; and on sitting, 5.6±2.5 vs. 2.5±3.8, P<0.001 | N/A | N/A | Not statistically significant | IV paracetamol and dexketoprofen given to all patients unless contraindicated; IV ondasetron and dexamethasone for anti-emesis; IV oxycodone to reduce systolic blood pressure |
| Yeşiltaş et al., 2021 (36) |
RCT | 56 | Control; ESPB group received bilateral 20-mL of 0.25% bupivacaine and 1.0% lidocaine | Sedation: midazolam; induction: fentanyl citrate + propofol + rocuronium; maintenance: sevoflurane + remifentanil; facilitation of dissecting muscles bilaterally: rocuronium | Morphine consumption was stastisctially significantly higher in the controls within the first postoperative 24-h in the ESPB participants (44.75±12.3 vs. 33.75±6.81 mg, P<0.001) | Except for postoperative 24th-hour VAS (P=0.127), all postoperative VAS scores recorded at all time-points (0, 1, 2, 6 and 12 h) were significantly higher in the controls (P<0.05) | Patient satisfaction scores were on average 4.54±0.8 in ESPB vs. 3.14±1.3 in the control group (P<0.001) | PLOS was significantly longer in the control participants than ESPB participants (3.3±0.98 vs.
1.71±0.76 days, P<0.001) |
Not statistically significant | Atropine for symptomatic bradycardia; IV paracetamol + tramadol 30 min before end of surgery |
| Yu et al., 2021 (37) | RCT | 80 | Control; ESPB received bilateral 30 mL of 0.25% bupivacaine | Induction: sufentanil + propofol; intubation: rocuronium; maintenance: propofol + remifentanil | Significantly fewer patients required sufentanil in the ESP-PCA group than in the PCA group (all P<0.0001); pethidine for rescue analgesia in PCA group was significantly higher than that in ESP-PCA group (245±13.13 vs. 96.25±13.68 mg, P=0.0001) | Numeric Rating Scale Pain at rest and during movement at 6, 12, and 24 h was lower in the ESP-PCA group (P<0.001, P<0.001, P<0.0016 at rest; all P<0.001 during movement) |
N/A | Post HLOS statistically significant (12.38±0.315 in ESP-PCA vs. 14.78±0.333 days in PCA, P=0.0001) | Post operative nausea was statistically significant (P=0.001) 4 people (10%) in ESP-PCA vs. 17 people (42%) in PCA; post operative vomiting was statistically significant (P=0.001) 3 people (7.5%) in ESP-PCA vs. 16 people (40%) in PCA | IV infusion of colloidal solution before induction; tropisetron IV to prevent nausea |
| Zhu et al., 2021 (38) | RCT | 40 | Control; ESPB received bilateral 20 mL 0.375% ropivacaine | Induction: sufentanil + rocuronium + propofol; maintenance: propofol + remifentanil | Oxycodone consumption in the first 48 h after surgery was significantly lower in the ropivacaine group than in the saline group [23.10 mg total (22.56–39.20) and 36.4 mg total (18.2–30.46)] respectively (P<0.05) | Rest and exercise VAS after surgery were significantly lower in the ropivacaine group than in the saline group (P<0.05) | N/A | N/A | Not statistically significant | IV sufentanil + flurbiprofen + tropisetron given 15 min before end of surgery |
| Ciftci et al., 2020 (39) | RCT | 90 | Control; ESPB received bilateral 20 mL of 0.25% bupivacaine; mTLIP block received bilateral 20 mL of 0.25% bupivacaine | Sedation: midazolam; induction: propofol + fentanyl + rocuronium; maintenance: sevoflurane | Postoperative opioid consumption at all time intervals were significantly lower both in ESPB and mTLIP groups compared with the control group 250 mg [150–375], 263 [150–375] and 375 [245–550] respectively (P<0.05) | Passive VAS score at the PACU, 2nd, 4th, and 8th hours, and active VAS score at the postanesthesia care unit, 2nd, 4th, 8th, and 16th hours were significantly lower in the ESPB and mTLIP groups compared with the control group (P<0.05) | N/A | N/A | Nausea only post-operative complication in which there was statistically significant difference between the ESPB (3/27 subjects) and mTLIP (3/27 subjects) group versus the control group (13/17 subjects) (P<0.001) | IV paracetamol + ramadol were given at the end of the surgery to all patients; remifentanil used for intraoperative analgesia |
LOS, length of stay; PLOS, patient length of stay; RCT, randomized controlled trials; ESPB, erector spinae plane block; PCA, patient-controlled analgesia; PACU, post-anesthesia care unit; IV, intravenous; VAS, visual analog scale; mTLIP, modified-thoracolumbar interfascial plane.