Erector spinae plane block as perioperative analgesia for midline sternotomy in cardiac surgery: A systematic review and meta‐analysis

Abstract

Background: Inadequate analgesia following cardiac surgery increases postoperative complications. Opioid-based analgesia is associated with side effects that may compromise postoperative recovery. Regional anesthetic techniques provide an alternative thereby reducing opioid requirements and potentially enhancing postoperative recovery. The erector spinae plane block has been used in multiple surgical procedures including sternotomy for cardiac surgery. We, therefore, aimed to characterize the impact of this block on post-sternotomy pain and recovery in cardiac surgery patients. Methods:We conducted an electronic search for studies reporting on the use of the erector spinae plane block in adult cardiac surgery via midline sternotomy. Randomized controlled trials, cohort studies, and case-control studies were considered for inclusion. Outcomes of interest included postoperative pain, timeto-extubation, and intensive care unit length of stay.Results: In total, 498 citations were identified and five were included in the metaanalysis. The erector spinae plane block did not significantly reduce self-reported postoperative pain scores at 4 h (−2.04; 95% confidence interval [CI] −8.15 to 4.07; p = .29) or 12 h (−0.27; 95% CI −2.48 to 1.94; p = .65) postextubation, intraoperative opioid requirements (−3.07; 95% CI −6.25 to 0.11; p = .05], time-to-extubation (−1.17; 95% CI −2.81 to 0.46; p = .12), or intensive care unit (ICU) length of stay (−4.51; 95% CI −14.23 to 5.22; p = .24).Conclusions: Erector spinae plane block was not associated with significant reduction in postoperative pain, intraoperative opioid requirements, time-toextubation, and ICU length of stay in patients undergoing cardiac surgery. The paucity of large randomized controlled trials and the high heterogeneity among studies suggest that further studies are required to assess its effectiveness in cardiac surgery patients.

Regional analgesia for lung transplantation

“…ESP block provides analgesia to the posterior and anterolateral hemithorax by blocking the posterior and anterior rami. Coverage of the anteromedial hemithorax is unreliable 57 . Local anaesthetic injection into the fascial plane between the thoracic transverse processes and the erector spinae muscle typically results in a T2–T9 block on the ipsilateral side.…”

“…Coverage of the anteromedial hemithorax is unreliable. 57 Local anaesthetic injection into the fascial plane between the thoracic transverse processes and the erector spinae muscle typically results in a T2-T9 block on the ipsilateral side. The advantages of ESP block include technical simplicity, direct ultrasound visualisation and possibly less hypotension.…”

Erector spinae plane blocks for cardiac surgery: Are we comparing apples to oranges?

“…They report no difference in postoperative pain scores, intraoperative opioids, time to extubation, and intensive care unit (ICU) length of stay in patients receiving ESPB versus no ESPB. 1…”

“…Additional limitations to this study exist. With regard to the validity of the meta‐analysis, forest plots in the King et al 1 analysis do not appear to be weighted for sample size. The authors do accurately identify high levels of heterogeneity with I 2 > 90% for all outcomes they examined, however, this does not remedy this limitation, and it could be argued that these studies should not have been combined in a meta‐analysis and instead reported in a narrative review 17 .…”

“…Using their described methodology, the authors found 498 articles through June 2021 and after excluding duplicate and irrelevant studies, completed 17 full article reviews, ultimately including 5 in their final analysis. They report no difference in postoperative pain scores, intraoperative opioids, time to extubation, and intensive care unit (ICU) length of stay in patients receiving ESPB versus no ESPB 1 …”