Erector spinae plane block for postoperative analgesia in cardiac surgeries- A systematic review and meta-analysis

Abhijit Nair, Praveen Saxena, Nitin Borkar, Manamohan Rangaiah, Nishant Arora, Prasanta Kumar Mohanty, Abhijit Nair, Praveen Saxena, Nitin Borkar, Manamohan Rangaiah, Nishant Arora, Prasanta Kumar Mohanty

Abstract

Ultrasound-guided erector spinae plane block (ESPB) has been used in many studies for providing opioid-sparing analgesia after various cardiac surgeries. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of ESPB in cardiac surgeries. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar to identify the studies in which ESPB was compared with the control group/sham block in patients undergoing cardiac surgeries. The primary outcomes were postoperative opioid consumption and postoperative pain scores. The secondary outcomes were intraoperative opioid consumption, ventilation time, time to the first mobilization, length of ICU and hospital stay, and adverse events. Out of 607 studies identified, 16 studies (n = 1110 patients) fulfilled inclusion criteria and were used for qualitative and quantitative analysis. Although, 24-hr opioid consumption were comparable in both groups group (MD, -18.74; 95% CI, -46.85 to 9.36, P = 0.16), the 48-hr opioid consumption was significantly less in ESPB group than control ((MD, -11.01; 95% CI, -19.98 to --2.04, P = 0.02). The pain scores at various time intervals and intraoperative opioid consumption were significantly less in ESPB group. Moreover, duration of ventilation, time to the first mobilization, and length of ICU and hospital were also less in ESPB group (P < 0.00001, P < 0.00001, P < 0.00001, and P < 0.0001, respectively). This systematic review and meta-analysis demonstrated that ESPB provides opioid-sparing perioperative analgesia, facilitates early extubation and mobilization, leads to early discharge from ICU and hospital, and has lesser pruritus when compared to control in patients undergoing cardiac surgeries.

Keywords: Analgesia; cardiac surgery; coronary artery bypass grafting; erector spinae plane block; postoperative; regional anesthesia; valve replacement.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the literature search process
Figure 2
Figure 2
(a)Traffic light plot showing the risk of bias within the trials. (b) Summary plot showing quality assessment for each included study
Figure 3
Figure 3
(a) Funnel plot of 24 and 48-hr postoperative opioid consumption in ESPB group versus control. (b) Funnel plot of 48-hr postoperative opioid consumption in ESPB group versus control
Figure 4
Figure 4
Forest plot showing comparison of opioid consumption at (a) 24-hr, (b) 48-hr, (c) intraoperative. (ESPB – erector spinae plane block, SD – standard deviation, CI – confidence interval, df – degree of freedom, IV – inverse variance)
Figure 5
Figure 5
(a and b) Forest plot showing comparison of pain scores at 0, 1, 2, 4, 6, 8, 10, 12, 16, 24 hours postoperatively between ESPB group and control (ESPB – erector spinae plane block, SD – standard deviation, CI – confidence interval, df – degree of freedom, IV – inverse variance)
Figure 6
Figure 6
Forest plot comparing-(a) Length of stay in ICU (b) Length of stay in the hospital (c) Duration of postoperative ventilation (d) Time to first mobilization (e) PONV (f) Pruritus (ESPB- erector spinae plane block, SD – standard deviation, CI-confidence interval, df – degree of freedom, IV – inverse variance, RR – risk ratio, PONV – postoperative nausea and vomiting)

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