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Meta-Analysis
. 2025 Jan;35(1):17-24.
doi: 10.1111/pan.15027. Epub 2024 Oct 15.

Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis

Rafael A Lombardi  1 , Eduardo M Pereira  2 , Sara Amaral  3 , Heitor J S Medeiros  4 , Walid Alrayashi  5
Affiliations
Meta-Analysis

Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis

Rafael A Lombardi et al. Paediatr Anaesth. 2025 Jan.

Abstract

Introduction: The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid-based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting.

Methods: We systematically reviewed and meta-analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3.

Results: Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg-1; 95% CI -3.15 to -0.66 μg.kg-1; p = .003; I2 = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I2 = 0%). No significant differences were found in the remaining outcomes.

Conclusion: Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS.

Prospero registration: CRD 42024526961.

Keywords: cardiac surgical procedures; erector spinae plane block; intravenous analgesia; pediatric surgery; postoperative pain.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Intraoperative fentanyl usage (1A), ICU LOS (1B), and hospital LOS (1C). Intraoperative fentanyl usage was statistically significantly lower in the ESPB group. ICU LOS was lower in the ESPB group, with statistical significance. No difference was found in both groups in the hospital LOS.
FIGURE 2
FIGURE 2
Extubation time (2A), Time to first analgesia rescue (2B), and vomiting (2C). Extubation time, time to first analgesia rescue, and vomiting incidence (3C) did not present statistically significant differences between groups.
FIGURE 3
FIGURE 3
RoB 2 (3A) and Robins‐I (3B) assessments.
See this image and copyright information in PMC

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