Efficacy and safety of single-shot erector spinae plane block for perioperative analgesia in pediatric surgery: a systematic review and meta-analysis

Background and Objective: Since its introduction in 2016, ultrasound-guided ESPB has been utilized in various surgical contexts. Numerous case reports and studies have suggested that ESPB in pediatrics can offer perioperative analgesia, but its clinical effects have remained controversial. Therefore, this review aims to comprehensively analyze the efficacy and safety of single-shot ESPB in pediatrics. Methodology: The literature search was electronically conducted in the Cochrane Library, PubMed, and Google Scholar databases, covering data available until December 2022. This meta-analysis encompassed English-language RCT that compared preoperative single-shot ESPB with a control group (no block or sham block) in pediatric patients (age < 18 y). The primary outcomes encompassed total intra and postoperative opioid consumption and the time first to rescue analgesia. Secondary outcomes comprised 24-hour postoperative pain scores, the incidence of PONV, and complications linked to local anesthesia and the ESPB procedure. Results: The analysis incorporated six RCTs, encompassing 320 samples. Single-shot ESPB demonstrated a reduction in intraoperative opioid consumption (MD: -0.54; 95% CI [-0.97, -0.11], I2 = 97%, P = 0.01, very low-quality certainty of evidence), 24-hour postoperative opioid consumption (MD: -0.12; 95% CI [-0.21, -0.02], I2 = 93%, P = 0.02, low quality certainty of evidence), and an extension in the time to the first rescue analgesia requirement (MD: 3.38; 95% CI [2.38, 4.39], I2 = 96%, P < 0.00001, very low-quality certainty of evidence). The ESPB group exhibited reduced postoperative pain scores at 0, 1, 4, and 6 h (P < 0.05); however, no significant differences were observed compared to the control group at 2, 12, and 24 h. The incidence of PONV was also significantly lower in the ESPB group (P = 0.04). Encouragingly, all six RCTs reported no instances of complications associated with local anesthesia and the ESPB procedure. Conclusion: This meta-analysis showed that ultrasound-guided single-shot ESPB in pediatrics diminished both intraoperative and postoperative opioid needs and also led to a decrease in occurrences of PONV. Furthermore, it effectively alleviated postoperative pain while maintaining safety against the potential risks of local anesthetic toxicity and complications linked to the ESPB procedure.