Efficacy of Erector Spinae Plane Block for Postoperative Pain Management in Breast Surgeries: A Systematic Review and Meta-analysis

Curr Pain Headache Rep. 2026 Feb 25;30(1):31. doi: 10.1007/s11916-026-01467-7.

Postoperative pain after breast surgery is common and can progress to chronic pain. Regional blocks like the erector spinae plane block (ESPB) could attenuate pain while limiting opioid consumption.

Methods

We searched PubMed, OneSearch, and Cochrane Library on May 2, 2025, for randomized controlled trials (2010–2025) evaluating the efficacy of an ESPB for postoperative pain in breast surgery. Thirteen trials (n = 856) met eligibility criteria. Pain (visual analogue or numeric rating scales) at 2, 4, 6, 12, and 24 h, cumulative 24-hour opioid consumption (converted to IV morphine equivalents), and time to first rescue analgesic were extracted. Medians and interquartile ranges (IQRs) were converted to means and standard deviations (SD) with the Wan method; pooled mean differences (MD) were calculated with inverse-variance random-effects models. Certainty was assessed using the GRADE approach; evidence profiles and a Summary of Findings table are provided.

Results

Eleven trials were used for the pain analysis. ESPB lowered pain scores from 2 hours (MD -0.83 units, 95% confidence intervals (CI), -1.64 to -0.02) through 24 h (MD -0.45, -0.86 to -0.05). Heterogeneity was high (I² > 95%). Five trials (n = 332) reported usable opioid data; ESPB reduced 24-hour opioid consumption by approximately − 2.1 mg IV morphine equivalents (-4.3 to 0.2, p = 0.07). Six trials (n = 402) showed ESPB delayed rescue analgesia by 3.64 h (0.71 to 6.56). Sensitivity analyses excluding high-risk studies yielded comparable results. Evidence certainty was moderate for pain, but low for opioid and rescue analgesia outcomes.

Conclusion

ESPB provides modest yet clinically relevant reductions in pain for the first 24 h after breast surgery and prolongs the interval before additional analgesia is required, with a trend toward opioid sparing. Given its technical simplicity and favorable safety profile, the ESPB represents a practical addition to multimodal enhanced recovery pathways. Larger, head-to-head trials are needed to refine effect sizes and explore long-term outcomes.

PMID:41739367 | DOI:10.1007/s11916-026-01467-7