Meta-analysis of erector spinae plane block efficacy in managing postoperative pain following cardiac surgery

Cardiac surgery is associated with significant postoperative pain, necessitating effective multimodal analgesia to reduce opioid-related morbidity. This systematic review and meta-analysis evaluated the analgesic efficacy of erector spinae plane block (ESPB) in adult cardiac surgery. Twenty-three randomized controlled trials (1,612 patients) were included. Primary outcomes revealed no significant difference in 24-hour postoperative coughing pain scores between ESPB and control groups (MD 0.12; 95 % CI:0.26 to 0.50; P = 0.54). However, ESPB demonstrated significant reductions in coughing and resting pain scores at 48 h (MD -0.60; 95 % CI:0.81to-0.38; P < 0.00001) and 72 h (MD -0.67; 95 % CI:1.02 to-0.33; P = 0.0001), alongside reduced 24-hour morphine consumption (MD -2.04; 95 % CI:2.46 to-1.61; P < 0.00001) and shorter mechanical ventilation duration (MD -26.53 minutes; 95 % CI:41.78 to-11.27; P = 0.0007). No differences were observed in ICU/hospital stays or surgical/anesthesia durations. Subgroup analyses highlighted variability in continuous versus single-shot ESPB techniques. High heterogeneity (I² >50 %) and moderate-to-low GRADE evidence underline the need for standardized protocols. ESPB shows promise in enhancing recovery by reducing opioid use and late-phase pain, though further high-quality trials are warranted.