Effect of erector spinae block on postoperative outcomes in patients undergoing lung surgical procedures: a systematic review and trial sequential analysis of randomized controlled trials

BACKGROUND: Lung surgery is often accompanied by significant pain, leading to high opioid use and related side effects. This systematic review and meta-analysis examine the effect of the erector spinae plane block (ESPB) in reducing postoperative pain, opioid consumption, and postoperative nausea and vomiting (PONV) after lung surgery. METHODS: A systematic database search was conducted to identify randomized controlled trials (RCTs) comparing ESPB with a control in patients undergoing lung surgical procedures. The primary outcome was the early (6 h), intermediate (12 h), and late (24 h) pain scores at rest and during movement. The secondary outcomes were 24 h postoperative opioid consumption and postoperative nausea and vomiting. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS: 20 RCTs with 1,391 patients were included in the meta-analysis (ESPB vs. control: 668 vs. 723). ESPB significantly reduced resting pain at 6 h (MD: 1.26; 95% CI: 0.78-1.75; p < 0.00001), 12 h (MD: 1.22; 95% CI: 0.41-2.03; p = 0.003), and 24 h (MD: 0.61; 95% CI: 0.33-0.90; p < 0.0001). Similarly, movement-evoked pain was reduced at 6 h (MD: 1.54; 95% CI: 0.71-2.37; p < 0.0001), 12 h (MD: 1.32; 95% CI: 0.88-1.76; p < 0.00001), and 24 h (MD: 0.91; 95% CI: 0.36-1.46; p = 0.001). Ten RCTs showed reduced 24-hour postoperative opioid consumption (MD: 16.74; 95% CI: 7.28-26.19; p = 0.0005) and decreased PONV incidence (OR: 0.32; 95% CI: 0.20-0.51; p < 0.001) in the ESPB group. Although statistically significant, the observed reductions in pain scores correspond to modest absolute differences of approximately 1-1.5 points on a 10-point scale in the early postoperative period and less than 1 point at 24 h. The certainty of evidence across all outcomes was low, primarily due to substantial clinical heterogeneity and variability in study protocols. CONCLUSION: ESPB appears to provide modest but consistent improvements in postoperative pain control, opioid consumption, and PONV after lung surgery. However, given the low certainty of evidence (GRADE) and substantial between-study heterogeneity, these findings support ESPB as an adjunct rather than a definitive regional analgesic strategy for lung surgery.