Erector spinae plane block for breast surgery: an umbrella review of systematic reviews and meta-analyses

Background: Postoperative pain remains a significant clinical concern following breast surgery, negatively impacting patient recovery and satisfaction. The erector spinae plane (ESP) block has gained popularity due to its opioid-sparing effect and ease of application. However, despite numerous systematic reviews and meta-analyses evaluating the efficacy of ESP block in breast surgery, methodological heterogeneity, varying study quality, and inconsistent findings have led to uncertainty regarding the strength and reliability of the evidence. Methods: In this umbrella review, we aimed to critically appraise, synthesize, and consolidate existing systematic reviews and meta-analyses to clarify the efficacy of the ESP block in breast surgery. We systematically searched The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PubMed Central, and Scopus from 2016 to 2025, to identify relevant systematic reviews and meta-analyses including patients undergoing breast surgery with ESP block compared to control interventions. Results: A total of six systematic reviews were included. Based on the Assessment of Multiple Systematic Reviews (AMSTAR)-2 assessment, two were rated as high quality, two as low quality, and the remaining two as critically low quality. All reviews consistently demonstrated that ESP block significantly reduced opioid consumption at 24 hours (mean reduction range: −4.93 to −7.67 morphine milligram equivalents). Pain scores at 0–2, 12, and 24 hours postoperatively were also significantly reduced, although the clinical relevance diminished at later time points. Additionally, ESP block was associated with a reduction in the incidence of postoperative nausea and vomiting (PONV). Conclusions: The ESP block consistently demonstrates efficacy in reducing postoperative pain, opioid consumption, and PONV in patients undergoing breast surgery. However, substantial methodological limitations and heterogeneity among existing systematic reviews underscore the need for more rigorous research and standardized reporting practices. The PROSPERO Registration: CRD420251002414, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002414.