Efficacy of an erector spinae plane block for renal colic: a systematic review and meta-analysis

Abstract

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. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Renal colic from kidney stones is often managed with non- steroidal anti- inflammatory drugs and opioids, but these treatments frequently fail to provide adequate pain relief and can lead to significant adverse effects. The erector spinae plane block (ESPB) has shown promise in perioperative and emergency settings, but its efficacy for renal colic in the ED was not well established. WHAT THIS STUDY ADDS ⇒ This systematic review suggests that ESPB significantly reduces pain in renal colic patients within 30–60 min postintervention compared with standard care, though the evidence is of very low certainty due to high risk of bias and small sample sizes. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ If validated by future high- quality trials, ESPB could offer a safer and more effective alternative to opioids for managing acute renal colic pain, potentially improving patient outcomes and satisfaction in the ED. as an asymptomatic incidental finding with limited clinical significance but also as a painful recurrent disorder with substantial morbidity.3 In recent decades, there has been a global rise in the inci dence of renal colic, accompanied by an increase in ED visits.3 4 © Author(s) (or their employer(s)) 2025. No commercial re- use. See rights and permissions. Published by BMJ Group. To cite: Candel BGJ, Visser LN, ter Avest E, et al. Emerg Med J 2025;42:317–323. 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.