Peripheral Nerve Blocks for Postoperative Pain Management in Cardiothoracic Surgery: A Systematic Review and Meta-analysis

To evaluate the effectiveness, comparative effectiveness, and safety of peripheral nerve blocks for postoperative pain management after cardiothoracic surgery.

Systematic review and meta-analysis of randomized controlled trials, with strength of evidence rated using the Agency for Healthcare Research and Quality methodology (PROSPERO CRD42024549561).

Perioperative care settings in studies published between 2013 and 2024.

Adults undergoing open or minimally invasive cardiothoracic surgery.

Peripheral nerve blocks, including chest wall blocks and erector spinae plane blocks, compared with sham, no block, local infiltration, or neuraxial techniques.

A total of 104 randomized controlled trials were included. Chest wall blocks reduced 24-hour pain scores and opioid consumption compared with sham or no block in both open cardiac and minimally invasive thoracic surgery. Erector spinae plane blocks demonstrated similar effects, with no clinically meaningful differences compared with chest wall blocks. Peripheral nerve blocks provided analgesia comparable to neuraxial techniques across several outcomes. Reported adverse events were rare and inconsistently defined.

Peripheral nerve blocks provide some reductions in postoperative pain and opioid use after cardiothoracic surgery and appear to have a favorable safety profile. Chest wall blocks and erector spinae plane blocks were found not to differ in effectiveness, and both offer analgesia comparable to neuraxial techniques.