Fascial plane blocks reduce opioid intake in cardiac surgery patients: BMC

A recent study published in the BMC Anesthesiology found that ultrasound-guided fascial plane blocks were efficient in reducing opioid consumption in patients undergoing open heart surgery. The study led by Burhan Dost and team undertook this systematic review and online meta-analysis to compare the effects of single ultrasound-guided regional anesthetics on postoperative opioid consumption.

This systematic review and online meta-analysis included cardiac surgery patients (age > 18 years) requiring median sternotomy. The team searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Web of Science. The effect of a single ultrasound-guided regional anesthesia technique was compared with a placebo without intervention and performed a risk assessment of eligible studies and assessed the overall quality of evidence for each outcome.

The primary outcome was opioid use within 24 hours of surgery. Secondary outcomes included pain after extubation at 12 and 24 hours, postoperative nausea and vomiting, time to extubation, time to ICU discharge, and length of hospital stay.

The key highlights of the study were:

A total of 15 studies with 849 patients were included.

Regional anesthetic techniques included pectoral-intercostal fascia block, transverse thoracic muscle plane block, erector spinae plane (ESP) and mammary nerve block I.

All regional anesthetic techniques significantly reduced opioid consumption at 2 hours postoperatively, expressed as morphine milligram equivalent (MME). ESP blockade was the most effective treatment (-22.93 MME [-34.29; -11.56]).

In conclusion, fascial plane blocks were better than placebo in evaluating 24-hour MMEs. However, due to the paucity of studies available in the literature, it remains difficult to determine which is better. More randomized controlled trials are needed to determine the efficacy of regional anesthetics.

Reference:

Dost, B., De Cassai, A., Balzani, E., Tulgar, S., & Ahiskalioglu, A. (2022). Effects of ultrasound-guided regional anesthesia in cardiac surgery: a systematic review and network meta-analysis. BMC Anesthesiology, 22(1), 409. https://doi.org/10.1186/s12871-022-01952-7