The Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block in Median Sternotomy Cardiac Surgery in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2792-2800. doi: 10.1053/j.jvca.2024.05.019. Epub 2024 May 22.

Abstract

Objectives: To assess the analgesic effect of erector spinae plane block in adults undergoing median sternotomy cardiac surgery.

Design and setting: The Cochrane, Embase, and PubMed databases from inception to January 2024 were searched. The study has been registered in the International Prospective Register of Systematic Reviews (CRD42023470375).

Participants: Eight randomized controlled trials involving 543 patients, comparing with no block or sham block, were included, whether it was a single injection or continuous.

Measurements and main results: The primary outcomes were pain scores and opioid consumption. Erector spinae plane block reduced pain scores immediately after extubation (mean difference [MD], -1.19; 95% confidence interval [CI], -1.67 to -0.71; p for heterogeneity = 0.10), at 6 hours after extubation (MD, -1.96; 95% CI, -2.85 to -1.08; p for heterogeneity < 0.0001), and at 12 hours after extubation (MD, -0.98; 95% CI, -1.55 to -0.40; p for heterogeneity < 0.00001). The decrease in pain scores reached the minimal clinically important difference within 6 hours. Opioid consumption 24 hours after surgery decreased by 35.72 mg of oral morphine equivalents (95% CI, -50.88 to -20.57; p for heterogeneity < 0.0001). Sensitivity analysis confirmed the stability of results. The quality of primary outcomes was rated as very low to moderate.

Conclusions: Erector spinae plane block decreased pain scores within 12 hours after extubation, reached the minimal clinically important difference within 6 hours, and decreased opioid consumption 24 hours after surgery, based on data of very low to moderate quality. However, high-quality randomized controlled trials are necessary to validate these findings.

Keywords: analgesic efficacy; cardiac surgery; erector spinae plane block; median sternotomy; meta-analysis.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Analgesia / methods
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / methods
  • Humans
  • Nerve Block* / methods
  • Pain, Postoperative* / etiology
  • Pain, Postoperative* / prevention & control
  • Paraspinal Muscles / diagnostic imaging
  • Paraspinal Muscles / innervation
  • Randomized Controlled Trials as Topic / methods
  • Sternotomy* / adverse effects
  • Sternotomy* / methods
  • Ultrasonography, Interventional* / methods