- Design
- systematic review and meta-analysis of comparative studies
- Population
- 10 studies of patients undergoing thoracic surgery or with chest wall trauma, from 2,141 records screened
- Primary outcome
- postoperative pain scores at 1, 24 and 48 hours and opioid consumption in morphine milligram equivalents
- Effect
- pain lower with ESPB at 1 h (p<0.00001), 24 h (p<0.00001) and 48 h (p=0.0008); opioid use no different at 24 h (p=0.10) or 48 h (p=0.20)
Ten studies were pooled comparing erector spinae plane block with intercostal nerve block for pain after thoracic surgery and chest wall trauma, with pain scored on numeric rating or visual analogue scales at 1, 24 and 48 hours and opioid use quantified as intravenous morphine milligram equivalents.
Pain scores favoured the erector spinae block at every time point: 1 hour (p < 0.00001), 24 hours (p < 0.00001) and 48 hours (p = 0.0008). But opioid consumption did not differ at 24 hours (p = 0.10) or 48 hours (p = 0.20), nor did hospital stay (p = 0.06) or time under analgesia (p = 0.33).
That combination is worth sitting with rather than glossing. Lower pain scores without lower opioid use can mean the analgesia is genuinely better and rescue opioid was given by protocol rather than by need; it can also mean the pain-score difference is small enough not to change behaviour. The report gives p-values without the effect sizes needed to tell which, so the honest summary is that the erector spinae block is at least as good and reports better pain, on ten studies of unstated size. For chest wall trauma in an emergency department, the more relevant advantage may be the technical one: a single injection into a plane away from the pleura, with landmarks that are easier under ultrasound in a patient who cannot sit still.
- Consider erector spinae plane block for rib fractures where the operator is trained in it
- Do not expect an opioid-sparing effect on this evidence
- Continue to monitor respiratory function after chest wall trauma regardless of block chosen
- Record pain scores at fixed times so the block's effect is visible
Why it matters
The two blocks are usually presented as interchangeable, and the pain data are not.
Don't overread it
Statistically significant pain-score differences without reported effect sizes or any opioid-sparing effect may not be clinically meaningful.
The statistics, in plain English
This meta-analysis reports p-values without mean differences, so how much lower the pain scores were is not stated — a difference can be highly significant and clinically trivial if the studies are large enough. That opioid consumption did not differ is evidence against a large analgesic gap. Ten studies pooled from 2,141 screened is a small final set, and the review does not report heterogeneity, which limits confidence further.
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