Efficacy of ultrasound-guided sacral erector spinae block in elective surgery. An up-to-date systematic review and meta-analysis of randomised controlled trials

Background and Aims: The sacral erector spinae plane block (SESPB) is emerging as a promising ultrasound-guided regional anaesthesia technique for postoperative pain management in various surgical procedures. This systematic review and meta-analysis aimed to investigate the efficacy of SESPB when used in combination with spinal anaesthesia. Methods: We conducted a search of PubMed/MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials, covering literature up to April 2025. Our analysis included randomised controlled trials (RCTs) that compared the outcomes of SESPB used with spinal anaesthesia against spinal anaesthesia alone in patients undergoing elective surgeries. The primary endpoint was the need for rescue opioid analgesics in the postoperative period. Secondary outcomes included postoperative pain levels at 12 and 24 h after surgery, the total amount of opioids consumed in the postoperative period and the time to the first opioid requirement after surgery. Results: We identified and included three RCTs in the quantitative analysis. The pooled data indicated that SESPB combined with spinal anaesthesia significantly reduced the need for rescue opioid analgesics compared with spinal anaesthesia alone (odds ratio = 0.05; 95% confidence interval = 0.02,0.16; P < 0.00001; I 2 = 14%). Additionally, the use of SESPB was associated with improved postoperative pain management at 24 h, although it did not yield a statistically significant reduction in the total amount of opioid consumed in the postoperative period and the timing of rescue opioid administration. Conclusions: This meta-analysis of RCTs indicated that the use of SESPB in conjunction with spinal anaesthesia results in a reduced need for rescue opioid analgesics and improved postoperative pain management at 24 h for patients undergoing elective surgery.