Comparing Regional Anesthesia Techniques in Open-heart Surgery

In a meta-analysis, published in BMC Anesthesiology, researchers compared the effects of different single-shot, ultrasound-guided, regional anesthesia techniques on postoperative opioid consumption in patients who underwent open-cardiac surgery. The authors noted that pain management during surgery is recommended to improve postoperative pain and functional recovery.

According to the analysis, erector spinae plane (ESP), pecto-intercostal fascial (PIF), and transversus thoracis muscle plane (TTMP) blocks all led to reduced opioid consumption after surgery compared with placebo, based on morphine milligram equivalents (MME) at 24 hours postoperation.

However, pectoralis nerve (PECS) I blocks did not demonstrate a statistically significant effect on MMEs after open-heart surgery. Additionally, the authors did not identify any single anesthesia technique as better than the others, citing a lack of available data for analysis.

Fascial Blocks Improved Open-cardiac Surgery Outcomes

The researchers analyzed 15 studies on regional and local anesthesia techniques with a combined total of 148 patients in the TTMP group, 183 in the PIF group, 93 in the ESP group, 20 in the PECS I group, and 405 in the control group.

The primary end point was opioid consumption in the first 24 hours following open-heart surgery, measured by 24-hour MMEs. Secondary end points included pain after extubation at 12 and 24 hours, extubation time, nausea, vomiting, and length of intensive care unit and hospital stays.

After analysis, researchers suggested that all regional anesthesia techniques reduced postoperative opioid consumption at 24 hours, with ESP block achieving the highest median MME reduction at −22.93 (range, −34.29 to −11.56).

The study ultimately concluded that ESP, PIF, and TTMP blocks reduced 24-hour MMEs compared with placebo. “Ultrasound-guided regional anesthesia is certainly a key analgesic technique in the context of cardiac surgery,” the investigators summarized.

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