Analgesic efficacy of erector spinae plane block for managing pain in arthroscopic shoulder surgery: a systemic review and meta-analysis

Background Whether the erector spinae plane block (ESPB) truly relieves pain after arthroscopic shoulder surgery (ASS) is still unsettled. We therefore examined whether ESPB sharpens post-operative pain control in these patients. Methods We systematically searched the Cochrane Library, PubMed, Embase, and Web of Science for randomized controlled trials (RCTs) comparing ESPB with any comparator (no block, sham block, or alternative regional block) in patients undergoing ASS. The primary outcome was cumulative opioid consumption within the first 24 h postoperatively. Secondary outcomes included pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), time to first rescue analgesic request, and patient-reported satisfaction with analgesia. Results Six RCTs comprised of 365 patients met inclusion criteria. ESPB did not reduce 24-h opioid consumption versus control (SMD −1.11; 95% CI −2.55 to 0.33; p = 0.13, I 2 = 96%). Pain scores were lower with ESPB at 2 h (SMD −0.83; 95% CI −1.30 to −0.37; p = 0.0005, I 2 = 35%) and 48 h (SMD −0.64; 95% CI −1.08 to −0.20; p = 0.004, I 2 = 95%), but not at 4 h. Furthermore, time to first rescue analgesic was prolonged by ESPB (SMD 4.04; 95% CI 0.77–7.31; p = 0.02, I 2 = 99%). However, ESPB did not reduce the rest and movement pain scores at 2 h (SMD −0.87; 95% CI −2.98 to 1.24; p = 0.42; I 2 = 97%; SMD −0.98; 95% CI −3.00 to 1.04; p = 0.34; I 2 = 97%) and 4 h (SMD −0.43; 95% CI −2.31 to 1.46; p = 0.66; I 2 = 97%; SMD −0.89; 95% CI −2.57 to 0.80; p = 0.30; I 2 = 96%), respectively. PONV and other adverse events were comparable. Subgroup analysis of single-injection ESPB also showed no opioid-sparing effect (SMD −1.46; 95% CI −3.21 to 0.30; p = 0.10, I 2 = 97%). Patient-reported satisfaction revealed no significant difference between ESPB and control group. Conclusion The ESPB fails to reduce 24-h opioid consumption, pain scores at rest and movement at early stage, and the incidence of PONV. Nevertheless, it prolonged the time to first rescue analgesic without elevating the risk of adverse events. Systematic review registration ROSPERO, registration number CRD 42023395027.