Cardiothoracic & vascular anaesthesia
Analgesic efficacy of locoregional anesthesia techniques in cardiac surgery: a systematic review and network meta-analysis of randomized trials
Authors' conclusion
IT demonstrated the largest reductions in opioid consumption and pain scores in the first 24 hours. ESPB and PIPB represent promising alternatives when neuraxial techniques are contraindicated, though effect sizes were smaller, often below thresholds of clinical relevance.
Study context
- Population
- Adults undergoing cardiac surgery
- Participants
- 9,816 adults · 133 RCTs
- Comparison
- Locoregional analgesia techniques vs control
- Outcome
- Opioid consumption, pain scores, and time to first rescue analgesia
- Follow-up
- Within 24 hours postoperatively
Methodological detailsBayesian random-effects, GRADE certainty assessment
- Bayesian random-effects
- GRADE certainty assessment
Pooled result
As reported in the abstract
24-hour opioid consumption (MME) · 24 hours
Each group vs controlMD, MME (95% CrI)
IT
−14.8(−20.7 to −9.2)
ESPB
−9.7(−14.8 to −4.9)
- Parasternal intercostal plane block (PIPB)
- MD −6.3 MME (95% CrI 10.5 to −2.3)
- Pain score on VAS at 24 hours, IT vs control (95% CrI −3.3; −0.7); IT produced the largest and consistent pain score reductions
- −1.2 cm
Further pooled results
| Outcome | MD (hours) (CrI) | |
|---|---|---|
| ICU LOSESPB vs Control | −8.3 (−13.7 to −2.8) | |
| ICU LOSPIPB vs Control | −7.2 (−12.2 to −2.3) | |
| ICU LOSTEA vs Control | −11.8 (−20.2 to −3.0) | |
| −30−20−10010Difference, hours (linear scale) |
| Outcome | MD (days) (CrI) |
|---|---|
| Hospital LOSTEA vs Control · reduced by; only TEA reduced hospital LOS | 1.2 (−1.7 to −0.6) |
Safety
- No major block-related complications were reported
Original publication
Analgesic efficacy of locoregional anesthesia techniques in cardiac surgery: a systematic review and network meta-analysis of randomized trials. Reg Anesth Pain Med. Published 25 June 2026. doi:10.
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