BACKGROUND AND AIM: The passage of kidney stones through the ureter creates renal colic, a severe visceral abdominal pain. Renal colic is typically managed with non-steroidal anti-inflammatory drugs and opioids. Yet, these treatments often fail to provide adequate pain relief. The erector spinae plane block (ESPB) has emerged as a potential alternative treatment. This systematic review summarises the current body of evidence on the efficacy and safety of ESPB for renal colic in the ED.
METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) and case series of ESPB in ED patients were conducted. PubMed, EMBASE, Web of Science and ClinicalTrial.gov databases were electronically searched up to 10 June 2024, for studies that compared ESPB with standard care or placebo. The Cochrane risk of bias-2 tool was used to assess the risk of bias of included studies. Meta-analysis using a random effects model was performed if two or more studies reported the same outcome. The Grading of Recommendations Assessment, Development, and Evaluation tool was used to assess the certainty of the evidence.
RESULTS: Four studies were included, including two RCTs and two case series. A total of 53 patients received an ESPB, compared with 40 patients who received standard care. All studies were rated as having a high overall risk of bias. Meta-analysis showed a large and significant effect of ESPB on pain reduction after 30 min (standardised mean difference (SMD) -1.41 95% CI -1.90 to -0.91) and after 60 min (SMD -1.94 95% CI -3.36 to -0.52), however the level of evidence was downgraded to very low certainty due to substantial heterogeneity (I2=85%), serious concerns of bias and large imprecision. Heterogeneity in other outcome measurements precluded meta-analysis.
CONCLUSIONS: Although statistically significant, there is a low certainty regarding the positive effect of ESPB on pain reduction for renal colic in the ED. High-quality RCTs focusing on patient-reported outcomes are needed to establish the merit of ESPB for this indication.
PROSPERO REGISTRATION NUMBER: CRD42024554077.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
When only 2 trials included so pooling of results has only marginal usefulness. It would seem that the block might have some value in patients refractory to standard treatment. The review provides a convenient cross section of the literature for this technique.
Physician rater
Renal colic pain is not an uncommon problem in emergency medicine. NSAIDs have become the 1st-line treatment, but opioids are still commonly used. Regional blocks may be an alternative as rescue in patients with failed pain relief from traditional systemic treatments and/or when there are contraindications for their use. Erector spinae plane block may in these cases be an option.
Physician rater
Finding out about the new technique for managing pain in renal colic is intriguing, but the study would be more beneficial if it had provided conclusive evidence to support or discourage using erector spinae plane block.
Physician rater
As an emergency physician, regional blocks are used frequently but definitely not the erector spinae plane block. Since overcrowding precludes our using it, this study may not improve management in most emergency settings, although new concepts for intractable pain is always helpful.
, McMaster University