Lombardi Rafael A, Pereira Eduardo M, Amaral Sara, Medeiros Heitor J S, Alrayashi Walid
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Division of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Paediatr Anaesth. 2025 Jan;35(1):17-24. doi: 10.1111/pan.15027. Epub 2024 Oct 15.
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.
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.
Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg; 95% CI -3.15 to -0.66 μg.kg; p = .003; I = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I = 0%). No significant differences were found in the remaining outcomes.
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.
CRD 42024526961.
竖脊肌平面阻滞（ESPB）最近已成为小儿心脏手术围手术期疼痛管理的一种区域麻醉技术。然而，将其与静脉注射（IV）阿片类镇痛药的有效性进行比较的证据有限。我们旨在评估和比较在此情况下ESPB与IV阿片类药物的镇痛效果。
我们系统回顾并荟萃分析了比较ESPB与IV阿片类镇痛在小儿心脏正中开胸手术中的研究。主要结局是术中芬太尼用量和重症监护病房（ICU）住院时间（LOS）。次要结局包括术后阿片类药物用量、首次补救镇痛时间、疼痛评分、术后呕吐及其他并发症、拔管时间和住院LOS。使用RStudio 4.2.3版本进行统计分析。
纳入了五项研究，共384例患者，其中178例接受ESPB。ESPB显著减少了术中芬太尼的使用（MD -1.90μg.kg；95%CI -3.15至-0.66μg.kg；p = 0.003；I² = 58%）和ICU住院时间（MD -3.50小时；95%CI -4.32至-2.69小时；p < 0.0001；I² = 0%）。其余结局未发现显著差异。
我们的研究结果表明，ESPB可能是增强小儿心脏手术正中开胸镇痛效果的重要辅助手段，有可能减少术中阿片类药物需求和ICU住院时间。
PROSPERO注册编号：CRD 42024526961。
