An Updated Meta‐Analysis of Randomized Controlled Trials Comparing the Analgesic Efficacy of Intercostal Nerve Block Versus Erector Spinae Plane Block in Thoracic Surgery
Muhammad Shaheer Bin Faheem, Syeda Umbreen Munir, Kanz Ul Eman Maryam, Sabahat Ul Ain Munir Abbasi, Sumaya SamadiBackground
ESPB, an ultrasound‐guided fascial plane block, gained considerable attention as a regional anaesthetic because of its longer duration of action, favourable safety profile, and multidermatomal analgesic effect. ICNB, however, is associated with a relatively short duration of action, often requiring repeated dosing and adjunctive systemic analgesics.
Methods
The methodology of this meta‐analysis adhered to the PRISMA 2020 guidelines and included randomized controlled trials comparing ESPB with ICNB in thoracoscopic surgery. A systematic PubMed, Cochrane, and ClinicalTrials.gov search was performed that reviewed the publications available till March 16, 2025. Studies were screened, data were extracted, and two reviewers independently evaluated the risk of bias using the Cochrane ROB 2 tool. Dynamic pain at 48 h was the primary outcome; the secondary outcome was analgesic use. Standardized mean differences (SMDs) or mean differences (MDs), as appropriate, with 95% confidence intervals were computed. Version 5.4 of Review Manager (RevMan) was used to process the statistical analysis, with a random‐effects model where necessary.
Results
We identified 444 records, out of which 6 randomized controlled trials were part of this meta‐analysis, totalling 353 cases: 176 being part of the ESPB group, while the remaining 177 constituted the ICNB group. For the principal outcome of dynamic pain score at 48 h postoperatively, combined analysis from five studies ( n = 295) revealed a statistically significant lowered pain score with ESPB in contrast to ICNB (SMD = −0.34, 95% CI: −0.57 to −0.10, p = 0.004; I 2 = 0%). For postoperative analgesic use, all six studies ( n = 353) data showed insignificant group difference (MD = 0.14, 95% CI: −1.04 to 1.32, p = 0.81; I 2 = 57%).
Conclusion
This study suggests that ESPB contributed to a reduction in pain scores at 48 h after thoracoscopic surgery compared with ICNB, yet both methods exhibited equivalent postoperative analgesic consumption. These findings show that ESPB can be a preferable option for prolonged postoperative analgesia; however, additional well‐designed studies are needed to corroborate the evidence base.