Effectiveness of Erector Spinae Plane Block (ESPB) for Idiopathic Scoliosis Surgery in Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Author(s): Priscila Pechim de Andrade, Verônica Pustrelo Damião, Ricardo Miranda Fliess de Castro, Vitor Leão Durães, Isabela Murray Lefevre, Sávila Josy de Alencar Melo, Daniel Erwin Schmidt, Elizabeth Mahanna, Arman Dagal

Background: This meta-analysis aims to evaluate the efficacy of the erector spinae plane block (ESPB) in enhancing postoperative analgesia following idiopathic scoliosis surgery in pediatric patients.

Methods: PubMed, Embase, and Cochrane Library were systematically searched in May 2025. Inclusion criteria were randomized controlled trials (RCTs) comparing ESPB versus no block or sham block for spinal surgery; patients under 21 years of age; and studies reporting immediate postoperative outcomes. Studies with overlapping populations or lacking a direct comparison between ESPB and no/sham block were excluded. Mean difference (MD) and standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled. Random-effects model was used, and all statistical analyses were performed using R version 4.4.2. Quality assessment and risk of bias were conducted according to Cochrane recommendations.

Results: Five RCTs comprising 249 patients were included, of whom 123 (49%) received the ESPB. Following spinal surgery, ESPB significantly reduced static pain scores at post-anesthesia care unit (PACU) arrival (MD = -3.12 mm; 95% CI: -3.50 to -2.73; p < 0.01) and the incidence of postoperative nausea and vomiting (PONV) (RR = 0.33; 95% CI: 0.13 to 0.82; p = 0.018) compared to control. However, no significant differences were observed between groups in opioid consumption over 24 hours, static pain scores at 12 and 24 hours, or dynamic pain scores at 24 hours postoperatively.

Conclusion: The findings suggest that the ESPB reduces pain scores at PACU arrival and PONV. Further research is needed to better understand the full effects and potential benefits of the ESPB in the pediatric population.