Bilateral Erector Spinae Plane Blocks versus Bilateral Transversus Abdominis Plane Blocks in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis

Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are used to improve patients' postoperative pain experiences. PubMed, CINAHL, Google Scholar, Cochrane Library, and gray literature were searched. Mean difference (MD) and risk ratio were used to estimate continuous and dichotomous variables. Quality of evidence was analyzed using Risk of Bias and GRADE. Sixteen studies involving 934 patients were analyzed. Compared with TAP block, ESP reduced resting (MD, -0.83; 95% confidence interval [Cl], -1.02 to -0.64; P < .00001) and dynamic pain intensity (MD, -0.71; 95% Cl, -0.93 to -0.50; P < .00001) in the first 24 hours lowered postoperative opioid consumption (MD, -4.52; 95% Cl, -5.99 to -3.04; P < .00001) and prolonged the time to first rescue analgesic (MD, 3.18; 95% Cl, 2.43 to 3.93; P < .00001). However, ESP was similar to TAP block for intraoperative opioid consumption, and the incidence of nausea or vomiting. Although the ESP block provided statistical superiority over the TAP block for acute pain management, the clinical relevance of the differences was small.