Erector spinae plane block for neuropathic pain management in
cardiac surgery via sternotomy: systematic review and meta-analysis

Gustavo Meneses Dantas; David Duarte de Araújo; João Alberto Pastor; Matheus Andrade Neves; Suely Pereira Zeferino; Filomena Regina Barbosa Gomes Galas

doi:10.63231/2595-0118.20250033-en

Review Article

Erector spinae plane block for neuropathic pain management in cardiac surgery via sternotomy: systematic review and meta-analysis

Bloqueio do plano do músculo eretor da espinha para o manejo da dor neuropática em cirurgias cardíacas por esternotomia: revisão sistemática com meta-análise

Gustavo Meneses Dantas; David Duarte de Araújo; João Alberto Pastor; Matheus Andrade Neves; Suely Pereira Zeferino; Filomena Regina Barbosa Gomes Galas

http://dx.doi.org/10.63231/2595-0118.20250033-en BrJP, vol.8, e20250033, 2025

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Abstract

BACKGROUND AND OBJECTIVES: Neuropathic pain after cardiac surgeries, particularly following sternotomy, is challenging to manage with opioids due to side effects and limited efficacy. The Erector Spinae Plane Block (ESPB), introduced in 2016, offers promising analgesia by reducing postoperative pain and opioid use. However, further trials are needed to validate its efficacy and safety. The objective of this study was evaluate the efficacy of the ESPB compared to conventional analgesia in controlling postoperative pain and reducing opioid consumption in cardiac surgeries.

CONTENTS: This systematic review and meta-analysis adhered to PRISMA guidelines. A comprehensive literature search was conducted in PubMed, SCOPUS, Cochrane, EMBASE, and Web of Science. Eligible studies included clinical trials examining the use of ESPB in cardiac surgeries. A total of 8 clinical studies met the inclusion criteria. Data analysis was performed using Review Manager (RevMan), with heterogeneity assessed by the I2 index. ESPB significantly reduced Intensive Care Unit (ICU stay (-27.10 hours, 95% CI: -27.21, -26.99) and intraoperative fentanyl consumption (-17.16 mg morphine-equivalent, 95% CI: -17.43, -16.88). Pain scores also showed notable reductions, particularly at the 4th hour post-extubation (-1.51, 95% CI: -1.98, -1.05) and the 6th hour (-0.67, 95% CI: -1.10, -0.25). Mean arterial pressure and heart rate showed no significant differences between the groups

CONCLUSION: ESPB shows promise in reducing postoperative pain, fentanyl use, extubation time and ICU stay in cardiac surgery. However, due to study heterogeneity, further randomized controlled trials are necessary to establish consistent recommendations.

Keywords

Analgesia; Cardiac surgery; Erector spinae plane bloc; ERAS (Enhanced Recovery After Surgery); Perioperative; Systematic review

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor neuropática após cirurgias cardíacas, especialmente esternotomias, é de difícil manejo com opioides, devido à sua eficácia limitada e aos efeitos adversos. O bloqueio do plano do músculo eretor da espinha (ESPB), descrito em 2016, surge como uma alternativa promissora por reduzir a dor pós-operatória e o consumo de opioides. Este estudo teve como objetivo avaliar a eficácia do ESPB em comparação à analgesia convencional no controle da dor e na redução do uso de opioides em cirurgias cardíacas.

CONTEÚDO: Esta revisão sistemática com meta-análise seguiu as diretrizes PRISMA. A busca bibliográfica foi realizada nas bases Pubmed, SCOPUS, Cochrane, EMBASE e Web of Science. Foram incluídos ensaios clínicos avaliando o uso do ESPB em cirurgias cardíacas. Oito estudos clínicos preencheram os critérios de inclusão. A análise estatística foi realizada no Review Manager (RevMan), e a heterogeneidade foi avaliada pelo índice I². O ESPB reduziu significativamente o tempo de internação em Unidade de Terapia Intensiva (UTI) (-27,10 horas; IC 95%: -27,21 a -26,99) e o consumo intraoperatório de fentanil (-17,16 mg equivalentes de morfina; IC 95%: -17,43 a -16,88). As escalas de dor também apresentaram reduções relevantes, especialmente na 4ª hora (-1,51; IC 95%: -1,98 a -1,05) e na 6ª hora (-0,67; IC 95%: -1,10 a -0,25) após a extubação. Pressão arterial média e frequência cardíaca não apresentaram diferenças significativas entre os grupos.

CONCLUSÃO: O ESPB demonstrou potencial para reduzir dor pós-operatória, consumo de fentanil, tempo de extubação e de internação em unidade de terapia intensiva em cirurgias cardíacas. No entanto, devido à heterogeneidade metodológica e ao risco de viés dos estudos incluídos, são necessários ensaios clínicos randomizados com maior rigor para confirmar esses achados e orientar recomendações clínicas consistentes.

Palavras-chave

Analgesia;Bloqueio do músculo eretor da espinha; Cirurgia cardíaca; ERAS (Recuperação Intensificada no Pós-operatório); Perioperatório; Revisão sistemática

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Submitted date:
12/04/2024

Accepted date:
05/06/2025