Erector spinae plane block in laparoscopic cholecystectomy: cutting pain, not just gallbladder (systematic review and meta-analysis of randomized controlled trials)

Background: Laparoscopic cholecystectomy (LC) is the gold standard for gallstone disease, but postoperative pain remains a challenge. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique; however, its comparative efficacy versus established methods such as transversus abdominis plane block (TAPB), port-site infiltration (PSI), or no block (NB) is not fully clarified. Materials and methods: This meta-analysis followed PRISMA and AMSTAR guidelines. Thirty-six randomized controlled trials (RCTs) published between 2018 and 2025, including adult patients who had LC were analyzed. ESPB was compared with TAPB (12 RCTs), PSI (5 RCTs), and NB (24 RCTs) with respect to pain scores, opioid consumption, time to rescue analgesia, intraoperative fentanyl use, and postoperative nausea and vomiting (PONV). Fixed- or random-effects models were used according to heterogeneity ( I 2 threshold 50%). Results: ESPB significantly reduced postoperative pain at rest and on movement compared with NB at all time points, with the greatest effect observed at 1–2 hours (MD: −1.82; P < 0.00001). Compared with TAPB, ESPB yielded lower resting pain at 1–2 and 6 hours, with modest differences at 12 and 24 hours. ESPB also demonstrated superiority over PSI at 12 hours but not at earlier or later intervals. Opioid consumption within 24 hours was markedly lower in the ESPB group (reductions of approximately 1.98–5.33 mg morphine equivalents), and time to first rescue analgesia was prolonged by 117–214 minutes depending on the comparator. ESPB further reduced intraoperative fentanyl use and significantly decreased PONV incidence versus TAPB, PSI, and NB. Conclusions: ESPB provides superior analgesia with reduced opioid consumption after LC, with additional benefits of prolonged pain relief and lower PONV rates. It should be considered an effective component of multimodal pain management in this setting.