Twenty-two randomized controlled trials including 1,327 patients undergoing lumbar spine surgery were included in this systematic review and meta-analysis comparing the erector spinae plane (ESP) block vs. placebo. Pooled outcomes of interest included pain scores at rest, pain scores during activity, opioid consumption, time to first analgesic rescue, the number of patients requiring rescue analgesia, the incidence of postoperative nausea and vomiting (PONV), and patient satisfaction. The pooled results showed that the ESP block significantly lowered pain scores both at rest and during activity, reduced opioid consumption, prolonged time to first analgesic rescue, decreased the number of patients requiring rescue analgesia, and lowered the incidence of PONV while improving patient satisfaction. These findings suggest that the ESP block is an effective method for improving postoperative pain management and reducing opioid use in patients undergoing lumbar spine surgery.