TOPLINE

In adults who underwent cardiothoracic surgery, peripheral nerve blocks of the chest wall or erector spinae were associated with modest reductions in postoperative pain and the use of opioids, and had few reported adverse events; however, the overall strength of evidence was low.

METHODOLOGY

• Investigators conducted a systematic review and meta-analysis of randomized controlled trials to assess the effectiveness, relative performance to other pain-control approaches, and safety of peripheral nerve blocks for pain after cardiothoracic surgery.
• They searched multiple databases and included trials (2013-2024) involving adults undergoing open or minimally invasive cardiothoracic procedures. The final analysis included 104 trials.
• Studies were grouped by surgery type: open cardiac, minimally invasive cardiac, open thoracic, and minimally invasive thoracic procedures. 
• Chest wall blocks and erector spinae plane blocks were each analyzed as single-shot or continuous techniques and compared with sham/no block, standard of care, local infiltration, neuraxial techniques, and each other; combined-block approaches were also evaluated
• For primary outcomes, researchers evaluated pain scores reported by patients at 24 hours or longer and the cumulative use of opioids in the hospital. A 1.5-point difference on a pain scale of 0-10 was considered the minimal clinically important difference.

TAKEAWAY

• Chest wall blocks were associated with lower 24‑hour pain and use of opioids after open cardiac surgery (four studies each). The strength of evidence was low, and some individual trials reported pain reductions with minimal clinically important difference.
• In minimally invasive thoracic surgery, patients who received single-shot erector spinae plane blocks had reductions in 24-hour pain scores by 0.82 points compared with those who received no block (four studies); the strength of evidence was low.
• In minimally invasive thoracic surgery, chest wall blocks were associated with reductions in 24-hour pain by 0.77 points (10 studies) and in the use of opioids (four studies); both outcomes had low strength of evidence.
• Erector spinae plane blocks showed no difference from neuraxial techniques in opioid use or length of hospital stay; chest wall blocks also showed no difference in length of stay. Adverse events were reported in a subset of studies, were rare, and were not formally graded.

IN PRACTICE

"[The] findings support the incorporation of PNBs [peripheral nerve blocks] into multimodal analgesia strategies for both open and minimally invasive cardiothoracic procedures, with selection guided by patient factors, procedural considerations, and institutional expertise," the researchers reported.

SOURCE

The study was led by Bronwyn J. Southwell, MD, of University of Minnesota in Minneapolis. It was published online on September 26 in the Journal of Cardiothoracic and Vascular Anesthesia.

LIMITATIONS

The review was limited by a shortage of large randomized controlled trials of high quality. Outcome measures and their timing varied widely across studies. Many trials had a high risk for bias owing to insufficient blinding, missing data, or deviations from protocol.

DISCLOSURES

The study received funding from the Agency for Healthcare Research and Quality of the US Department of Health and Human Services in partnership with the Patient-Centered Outcomes Research Institute. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.