Analgesic efficacy of uni-level erector spinae plane block in breast cancer surgery patients: a systematic review and Meta-analysis.
Basma M El-Khalifa, Hamza Khelifa, Mahmoud Mohamed Gad et al.
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In 30 seconds
This systematic review and meta-analysis assessed uni-level erector spinae plane block (ESPB) as an adjunct to general anesthesia and opioids for breast cancer surgery. Compared with control procedures, ESPB was associated with lower postoperative pain scores, longer analgesia, and reduced postoperative morphine consumption. The pooled mean difference in analgesia duration was 7.03 (95% CI 4.92, 9.14; P < 0.0001), while morphine consumption was lower by a mean difference of -5.77 (95% CI, -7.89, -3.65; P < 0.0001). The authors caution that high heterogeneity, risk of bias, and low certainty limit confidence in these findings.
Key findings
- ESPB was associated with longer analgesia duration: MD 7.03 (95%CI 4.92, 9.14, P < 0.0001).
- Postoperative morphine consumption was lower with ESPB: MD -5.77 (95% CI, -7.89, -3.65; P < 0.0001).
- VAS pain scores, 24-hour NRS scores, intraoperative fentanyl, and postoperative tramadol consumption decreased with ESPB; 12-hour NRS scores did not differ significantly.
Why it matters
Postoperative pain and opioid use are relevant outcomes after breast cancer surgery. The pooled findings suggest ESPB may improve analgesia and reduce opioid requirements when added to standard anesthetic care. However, the reported heterogeneity and low certainty mean the results should be interpreted cautiously rather than treated as definitive evidence of benefit.
What to keep in mind
Heterogeneity was high, and most included studies had high or unclear risk of bias; the authors also judged the evidence to be of low certainty.