SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Analgesic efficacy of erector spinae plane block for managing pain in arthroscopic shoulder surgery: A systemic review and meta-analysis
Provisionally accepted
- 1Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China
- 2Pengzhou People's Hospital, Pengzhou, China
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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, I² =96 %). Pain scores were lower with ESPB at 2 h (SMD -0.83; 95% CI -1.30 to -0.37; P=0.0005, I²=35 %) and 48 h (SMD -0.64; 95% CI -1.08 to -0.20; P=0.004, I² = 95 %), but not at 4 h. Furthermore, time to first rescue analgesic was prolonged by ESPB (SMD 4.04; 95% CI 0.77 to 7.31; P=0.02, I²=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; I² = 97 %; SMD -0.98; 95 % CI -3.00 to 1.04; P=0.34; I²=97 %) and 4h (SMD -0.43; 95 % CI -2.31 to 1.46; P = 0.66; I² = 97 %; SMD -0.89; 95 % CI -2.57 to 0.80; P=0.30; I²=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, I²=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.
Keywords: Erector spinae plane block, Analgesia efficacy, Arthroscopic shoulder surgery, Pain mamgement, meta analysis
Received: 26 Sep 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Wang, Yang, Jie, Liu and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fenglin Jiang
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