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Abstract
Background and Aims Off-pump coronary artery bypass (OPCAB) surgery is a widely performed surgical procedure for coronary artery disease. Adequate postoperative pain management is crucial for patient overall recovery. The erector spinae plane block (ESPB) has gained recognition as a promising regional anesthesia technique. Our aim is to compare standard pain management with the ESPB in patients undergoing OPCAB.
Methods Pubmed, EMBASE, and Cochrane were searched for randomized controlled trials (RCTs) comparing bilateral ESPB to control. We assessed pain scores, opioid consumption, and duration of mechanical ventilation, intensive care unit (ICU) and hospital stay. Data was analyzed with RevMan 5.4.
Results We analyzed 4 RCTs with 267 patients, of whom 50.56% underwent the ESPB. The pain scores at 6 and 12 hours after extubation were significantly decreased in the ESPB group (figure 1) but not at 24 hours (MD -1.37; 95% CI -2.95 to 0.20; p < 0.09; I2 = 93%, 3 RCTs, 238 patients). Opioid consumption also favoured the ESPB group (MD -14.30; 95% CI -21.39 to -7.22; p < 0.0001; I2 = 98%, 3 RCTs, 238 patients). Time to extubation was significantly shorter for the ESPB intervention (figure 2), as well as the ICU and hospital lengths of stay (figure 3).
Pain scores at 6h (A) and 12h (B) were significantly lower in the ESPB group
Time-to-extubation was significantly lower in the ESPB group
There was a significant difference in length of stay in the intensive care unit (3A) and in the hospital (3B), favouring the ESPB intervention
Conclusions ESPB may reduce opioid consumption, extubation time, ICU and hospital stay after OPCAB. It effectively reduces pain at 6 and 12 hours post- extubation, but not at 24 hours, probably due to its duration. Larger studies are needed for comprehensive conclusions.