Erector spinae plane block versus transversus abdominis plane block on postoperative analgesia among patients undergoing hysterectomy: A systematic review and meta-analysis of randomized controlled trials

ABSTRACT Background: While the transversus abdominis plane block (TAPB) is commonly used for postoperative analgesia after abdominal procedures, the erector spinae plane block (ESPB) has recently gained attention as an alternative regional anesthesia technique with potential advantages in managing visceral pain. We aimed to conduct a systematic review and meta-analysis to assess the analgesic efficacy of ESPB compared to TAPB under ultrasound guidance following hysterectomy. Materials and Methods: A comprehensive search was conducted across PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus to identify randomized controlled trials (RCTs) comparing ESPB versus TAPB for pain relief in patients undergoing hysterectomy through January 2026. Meta-analysis was conducted using RevMan software: Review Manager (RevMan), version 5.4.0, The Cochrane Collaboration, Copenhagen, Denmark. The primary outcome was postoperative pain intensity assessed by the 10-cm visual analog scale (VAS), with clinical significance evaluated using minimal clinically important difference (MCID) analysis (threshold 1.0 cm). Secondary outcomes included postoperative opioid consumption and incidence of nausea and vomiting. Results: Six RCTs involving 447 patients were included. ESPB demonstrated significantly lower VAS pain scores compared to TAPB at 2, 4, 6, 12, and 24 h postoperatively ( P < 0.001). MCID analysis revealed that clinical benefit was most pronounced in the early postoperative period, particularly at 2 h. Patients receiving ESPB had significantly lower 24-h opioid consumption ( P < 0.001) and reduced incidence of postoperative nausea and vomiting (PONV) ( P = 0.004). Conclusion: ESPB demonstrates superior analgesia compared to TAPB following hysterectomy, particularly in the early postoperative period, with reduced opioid consumption and PONV incidence. Further research with standardized protocols is warranted.