Erector spinae plane block in pediatric surgery: a systematic review and meta-analysis

BACKGROUND: The Erector Spinae Plane Block (ESPB) is a well-known regional anesthesia technique in adults. However, its effectiveness and analgesic efficiency have yet to be fully established in children. This meta-analysis aimed to determine the analgesic efficacy of ESPB in pediatric surgery. METHODS: Following PRISMA guidelines, we conducted a meta-analysis of prospective randomized clinical trials that compared the effects of ESPB versus the control group or different peripheral nerve blocks in pediatric surgery. RESULTS: Ten randomized controlled trials, involving 651 pediatric patients, were included in the synthesis following critical appraisal. Compared to no-block analgesia, ESPB significantly prolonged the time to the first rescue analgesia (SMD 1.30, 95% CI 0.38 to 2.22; p = 0.005) and reduced postoperative opioid consumption at 24 h (SMD -1.08, 95% CI -2.03 to -0.13; p = 0.03). ESPB also significantly lowered pain scores at 4 h (p = 0.008) and 6 h (p = 0.0003) postoperatively compared to no-block analgesia. However, ESPB did not significantly reduce intraoperative fentanyl consumption (SMD -0.21, 95% CI -1.14 to 0.71; p = 0.65). CONCLUSION: ESPB improved analgesic efficacy in pediatric surgery, particularly compared with caudal or no-block analgesia; however, the overall certainty of evidence ranged from low to moderate according to the GRADE approach. Further high-quality, methodologically robust RCTs are required. TRIAL REGISTRATION: The study was registered in the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42023483105).