Mary O'Dell Duplechin, Sydney A Mashaw, Sydney J Schwab, Andre J Mira, Macie A Serio, Shahab Ahmadzadeh, Benjamin C Miller, Sahar Shekoohi, Alan D Kaye
While ESPB provides superior pain relief at all measured time points postoperatively, there were no significant differences in postoperative opioid consumption, hospital stay, or time under analgesia between ESPB and ICNB. Both techniques effectively manage thoracic pain, but ESPB offers enhanced analgesic effects. Further research is necessary to refine these techniques and establish clearer guidelines for their use in specific clinical contexts.
BACKGROUND: Thoracic surgeries and chest wall traumas often result in severe postoperative pain, leading to significant morbidity and prolonged hospital stays. Intercostal nerve blocks have been a common strategy for managing this pain. In this regard, the ESPB is being utilized increasingly as a promising alternative as it offers more extensive pain relief and has a better safety profile.
OBJECTIVE: A meta-analysis comparing analgesic efficacy, measured by pain scores and opioid consumption, as well as hospital length of stay and time spent under analgesia, between ESPB and ICNB in patients undergoing thoracic surgeries and chest wall trauma was performed.
METHODS: A systematic literature search was conducted across three databases, identifying 2,141 potential studies. After eliminating duplicates (n = 728), the remaining studies were screened in two stages: initially by reviewing abstracts and titles (n = 1,413), followed by a full-text review of the remaining studies (n = 10). These selected studies assessed postoperative pain scores and opioid consumption. Pain was measured using the Numeric Rating Scale (NRS) and Visual Analog Scale (VAS) at 1 h, 24 h, and 48 h postoperatively, while opioid consumption was quantified in intravenous morphine milligram equivalents at 24 and 48 h.
RESULTS: The ESPB demonstrated significantly lower pain scores at 1 h (P < 0.00001), 24 h (P < 0.00001), and 48 h (P = 0.0008) postoperatively compared to the ICNB. Postoperative opioid consumption, measured in intravenous morphine milligram equivalents at 24 h (P = 0.10) and 48 h (P = 0.20) showed no significant difference between the two groups. Additionally, there were no significant differences observed in hospital stay duration (P = 0.06) or time spent under analgesia (P = 0.33).
CONCLUSION: While ESPB provides superior pain relief at all measured time points postoperatively, there were no significant differences in postoperative opioid consumption, hospital stay, or time under analgesia between ESPB and ICNB. Both techniques effectively manage thoracic pain, but ESPB offers enhanced analgesic effects. Further research is necessary to refine these techniques and establish clearer guidelines for their use in specific clinical contexts.