Evaluation of Different Pain-Control Procedures for Post-cardiac Surgery: A Systematic Review and Network Meta-Analysis

Abstract

Objective To identify superior pain-control procedures for postoperative patients who undergo cardiac surgeries. Methods Literature searches were conducted in globally recognized databases, including MEDLINE, EMBASE and Cochrane Central, to identify randomized controlled trials (RCTs) investigating pain-control procedures after cardiac surgeries. The parameters evaluating analgesic efficacy and postoperative recovery, namely, the pain score and ICU stay, were quantitatively pooled and estimated using Bayesian methods. The values of the surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated to enable the ranking of various pain-control procedures. Node-splitting analysis was performed to test the inconsistency of the main results, and the publication bias was assessed by examining the funnel-plot symmetry. Results After a detailed review, 13 RCTs containing 7 different procedures were included in the network meta-analysis. After pooling the results together, an erector spinae plane block (ESPB) and a local parasternal block (LPB) plus target-controlled infusion (TCI) presented the best analgesic effects for reducing pain at rest (SUCRA, .47) and during movement (SUCRA, .52), respectively, while the former also achieved the shortest ICU stay (SUCRA, .48). Moreover, the funnel-plot symmetries showed no inconsistencies or obvious publication bias in the current study. Conclusions The current evidence indicates that ESPB is a potential superior analgesic strategy for post-cardiac surgery patients. To verify this conclusion further, it is imperative to obtain more high-quality evidence and conduct relevant investigations in the future.

Regional anesthesia in cardiac surgery and electrophysiology procedures

“…When compared with systemic analgesia, patients who received continuous PVB had decreased hospital LOS (5.8 vs. 8.3 d) and an increased likelihood of not requiring postoperative opioids (48% vs. 24.5%) 31 . When compared with TEA for MIDCAB, the PVB catheter produced an effective analgesia and the authors concluded that PVB is easier and may be safer than TEA 33 …”

“…As it compares with the parasternal intercostal plane block, a meta-analysis found that the ESP block resulted in lower pain scores at rest; however, dynamic pain scores were shown to be lower with the parasternal intercostal plane block 31 . Performing the ESP and parasternal intercostal plane block in combination may have some utility as it has been shown to improve patient satisfaction, reduce pain scores, and decrease the need for rescue analgesics; however, the combined blocks only reduced morphine consumption by 5 mg in the first 24 hours which may not have clinical significance 32 …”

Effects of ultrasound-guided regional anesthesia in cardiac surgery: a systematic review and network meta-analysis

“…The impact of the ESP and TTMP blocks on ICU LOS is significant and favorable. Another NMA that evaluates the effects of fascial blocks in cardiac surgery can be found in the literature, but this one does not discriminate between sternotomy and non-sternotomy procedures, and this is a major limitation, as these are quite different procedures in terms of postoperative pain compared to each other [ 37 ]. In-hospital LOS is assessed only for PIF and TTMP blocks and is not statistically significant.…”