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Background <p>The use of erector spinae plane (ESP) block has been reported to decrease opioid requirements for patients undergoing bariatric and metabolic surgeries (BMS). We aim to systematically review and examine the evidence for the&#xa0;use of ESP block&#xa0;in BMS.</p> Methods <p>MEDLINE, Embase, Scopus, and CENTRAL electronic databases were searched for all studies on ESP block in BMS from database&#xa0;inception&#xa0;through 21st July 2025. Two reviewers&#xa0;independently&#xa0;assessed and selected studies, collected data, assessed the risk of bias and quality of evidence. The primary outcome for this review is opioid consumption in 24 h post-operation. Secondary outcomes include intraoperative opioid consumption, time to first request for analgesia, and postoperative pain scores.</p> Results <p>Nine randomised control trials involving 613 patients were found to be eligible. ESP block significantly reduced opioid consumption in the first 24 h after surgery, with a mean oral morphine equivalent daily dose&#xa0;(oMMED)&#xa0;reduction of 36.94 mg (95% CI -60.85 to -13.03, <i>p</i> = 0.009, I<sup>2</sup> = 94%).&#xa0;Trial sequential analysis (TSA) suggests a potential benefit of ESP block though this interpretation is limited by marked statistical heterogeneity. Time to first request for analgesia was significantly prolonged with ESP block. Intraoperative opioid requirements, time to first request for analgesia, and postoperative reported pain scores were reduced in the ESP block group.</p> Conclusions <p>Current evidence suggests that the bilateral ultrasound-guided ESP block may be a practical technique to improve perioperative pain control and reduce opioid usage in patients undergoing BMS.&#xa0;However, these findings must be interpreted with caution due to the&#xa0;very low&#xa0;to moderate certainty of evidence and high clinical heterogeneity.</p>

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Erector spinae plane block in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials with trial sequence analysis

  • 期刊论文

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  • 发表日期：

    2026年8月5日

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  • Chi Ho Chan,
  • Wen Jie Mak,
  • Kaiquan Tan,
  • Jacqueline Sim

摘要

Background

The use of erector spinae plane (ESP) block has been reported to decrease opioid requirements for patients undergoing bariatric and metabolic surgeries (BMS). We aim to systematically review and examine the evidence for the use of ESP block in BMS.

Methods

MEDLINE, Embase, Scopus, and CENTRAL electronic databases were searched for all studies on ESP block in BMS from database inception through 21st July 2025. Two reviewers independently assessed and selected studies, collected data, assessed the risk of bias and quality of evidence. The primary outcome for this review is opioid consumption in 24 h post-operation. Secondary outcomes include intraoperative opioid consumption, time to first request for analgesia, and postoperative pain scores.

Results

Nine randomised control trials involving 613 patients were found to be eligible. ESP block significantly reduced opioid consumption in the first 24 h after surgery, with a mean oral morphine equivalent daily dose (oMMED) reduction of 36.94 mg (95% CI -60.85 to -13.03, p = 0.009, I2 = 94%). Trial sequential analysis (TSA) suggests a potential benefit of ESP block though this interpretation is limited by marked statistical heterogeneity. Time to first request for analgesia was significantly prolonged with ESP block. Intraoperative opioid requirements, time to first request for analgesia, and postoperative reported pain scores were reduced in the ESP block group.

Conclusions

Current evidence suggests that the bilateral ultrasound-guided ESP block may be a practical technique to improve perioperative pain control and reduce opioid usage in patients undergoing BMS. However, these findings must be interpreted with caution due to the very low to moderate certainty of evidence and high clinical heterogeneity.