Work

Analgesic efficacy and safety of erector spinae plane block after sternotomy and minimally invasive cardiac surgery: A systematic review and Meta-analysis of randomized trials

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background The erector spinae plane block (ESPB) is increasingly used for analgesia in cardiac surgery, but its effectiveness across surgical approaches remains uncertain. We aimed to evaluate the analgesic efficacy, recovery effects, and safety of ESPB in adult cardiac surgery, with analyses stratified by surgical approach (median sternotomy versus minimally invasive cardiac surgery [MICS]). Methods We searched MEDLINE, Embase, CENTRAL, and Scopus (January 2016–June 2025) for randomized controlled trials (RCTs) comparing ultrasound-guided ESPB with standard systemic analgesia in adults undergoing cardiac surgery. This PRISMA-compliant review (PROSPERO: CRD42024570340) used random-effects meta-analyses with Hartung–Knapp adjustment. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. The primary outcome was postoperative pain within 24 h. Secondary outcomes included opioid consumption, time to extubation, ICU and hospital length of stay, and complications. Results Nineteen RCTs ( N = 1344; 673 received ESPB) were included. In the median sternotomy subgroup ( n = 1092), ESPB was associated with modest improvements in 24-h pain (0–10 VAS/NRS; mean difference [MD] −0.65, 95% CI − 1.14 to −0.16), intraoperative and 24-h opioid consumption (MD − 80.8 and − 45.8 mg OME), time to extubation (MD −1.28 h), and ICU stay (MD −13.1 h). However, heterogeneity was substantial (I 2 > 85% for most outcomes), and wide prediction intervals crossed the null, suggesting that effects may vary substantially across clinical settings. In the MICS subgroup (4 RCTs, n = 252), no clear statistically significant or clinically meaningful benefits were detected for most outcomes in pain, opioid use, or recovery outcomes. Conclusion Low- to very-low-certainty evidence suggests that ESPB is associated with modest improvements in early pain and recovery after median sternotomy; however, very high heterogeneity and wide prediction intervals indicate that effects may vary substantially between centers. In contrast, no clear benefit was demonstrated within ERAS-optimized MICS pathways, and findings in this subgroup remain preliminary.

Source: Journal of Clinical Anesthesia

DOI: 10.1016/j.jclinane.2026.112240

Authors: Diana Perez-Moreno, Mauricio Forero, María Fernanda Contreras, Javier Andres Mora-Arteaga

Institutions: Instituto Nacional de Cancerología, McMaster University, Universidad de La Sabana, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio

Language: English

Topic: Anesthesia and Pain Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,090