Erector spinae plane block for postoperative analgesia in vertebral surgery: an umbrella review of systematic reviews and meta-analyses

Background: The erector spinae plane (ESP) block has gained attention as a regional anesthesia technique for pain management in vertebral surgeries. This umbrella review synthesizes data from systematic reviews (SRs) and meta-analyses to evaluate the effectiveness of the ESP block in reducing postoperative opioid consumption, pain, and postoperative nausea and vomiting (PONV) in patients undergoing vertebral surgeries. Methods: A search was conducted in CENTRAL, Embase, PubMed Central, and Scopus from 2016 to 2025. The authors included SRs and meta-analyses that investigated the use of the ESP block in vertebral surgeries. Primary outcomes were opioid consumption at 24 postoperative hours (measured as milligrams of morphine equivalent), pain scores at 12 and 24 hours, PONV incidence, and the need for additional analgesics. Quality was assessed using the AMSTAR 2 tool. Results: Thirteen SRs were included. The ESP block reduced opioid consumption at 24 postoperative hours (mean morphine equivalents difference, -8.70 to-18.69), although high heterogeneity was observed. Pain reduction at 12 and 24 hours was statistically significant but clinically modest, with most SRs reporting reductions of less than one point in Numeric Rating Scale or Visual Analog Scale pain scales. The ESP block also significantly reduced PONV and additional analgesic use. However, most SRs were rated as low quality due to inadequate pre-registration and justification for excluding studies. Conclusions: The ESP block demonstrates potential as a multimodal analgesia component in vertebral surgeries, reducing opioid consumption, pain intensity, and PONV. However, high heterogeneity and low methodological quality highlight the need for further research.