Paravertebral Block versus Erector Spinae Plane Block for Postoperative Analgesia and Recovery: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis was performed to assess the relative efficacy of paravertebral block (PVB) and erector spinae plane block (ESPB) for postoperative analgesia and recovery.

Methods: Randomized controlled trials (RCTs) evaluating PVB and ESPB for postoperative analgesia and recovery were retrieved from databases, including PubMed, Embase, MEDLINE, Cochrane Library, Science-Direct, and Google Scholar, from inception to January 2025. The primary outcome included resting Visual Analogue Scale (VAS) at 6 h and quality of recovery (QoR) score in first 24 h. The meta-analysis was conducted using Stata 15.1 software. The certainty of the evidence was assessed utilizing the risk of bias and GRADE frameworks.

Results: We included 33 RCTs with 2256 patients. For resting VAS at 6 h, there was no significant difference between PVB and ESPB (mean difference [MD] = -0.08, 95% confidence interval [CI]: -0.44 to 0.27). For QoR, there was no significant difference between PVB and ESPB (MD = -0.44, 95% CI: -2.64 to 1.76). For resting VAS at 12 h, ESPB had a lower VAS than PVB. For resting VAS at 24 h, movement VAS at 6 h, 12 h, 24 h, time of first rescue analgesia, LOS, and postoperative nausea and vomiting (PONV), there were no significant differences between PVB and ESPB. However, PVB had a lower morphine consumption than ESPB.

Conclusion: There were no significant clinical differences between PVB and ESPB in terms of the VAS, QoR, time of first rescue analgesia, LOS, and PONV. Based on existing evidences, we recommended the application of ESPB in thoracic surgery, breast surgery, kidney surgery, and abdominal surgery.

Limitation: The included studies showed considerable variability in postoperative analgesia protocols, which increased heterogeneity in the results. There was a lack of data on long-term analgesia and functional outcomes.