Cardiothoracic & vascular anaesthesia
Effects of deep parasternal intercostal plane block on opioid consumption and pain after cardiac surgery: a meta-analysis of randomized controlled trials with meta-regression and trial sequential analysis
Pooled resultResult — go to the resultMD −9.38 mg MME 95% CI −14.72 to −4.03Authors' conclusion
There is very low-certainty evidence supporting a modest reduction in 24-h opioid consumption and early postoperative pain with D-PIP block. In contrast, high-certainty evidence supports a significant reduction in the incidence of PONV.
Study context
- Population
- Adults undergoing cardiac surgery
- Participants
- 1,165 adults · 17 randomized controlled trials (RCTs)
- Comparison
- Deep parasternal intercostal plane (D-PIP) block vs standard or placebo analgesia
- Outcome
- Opioid use, as morphine milligram equivalents (MME)
- Follow-up
- 24 h
Methodological detailsrandom-effects model, meta-regression, trial sequential analysis, prespecified subgroup analyses, sensitivity analysis, Risk of bias assessed with RoB 2; certainty with GRADE, Evidence certainty low-very low overall and high for postoperative nausea and vomiting (PONV)
- Random-effects model
- Meta-regression
- Trial sequential analysis
- Prespecified subgroup analyses
- Sensitivity analysis
- Risk of bias assessed with RoB 2; certainty with GRADE
- Evidence certainty low-very low overall and high for PONV
Pooled result
As reported in the abstract
MD
−9.38 mg MME
95% CI −14.72 to −4.03
D-PIP block vs Controls
MD −9.38 mg MME (95% CI −14.72 to −4.03)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| PONV incidenceI2 = 0% · high-certainty evidence | 0.30 (0.18–0.52) | |
| 0.20.5125Odds ratio (log scale) |
Pain scores at rest and movement · all time points
- Lower at all time points with D-PIP block
- Substantial heterogeneity
Extubation time, ICU length of stay (LOS) and hospital LOS
- Extubation time and ICU LOS shorter; hospital LOS unchanged
Heterogeneity (meta-regression)
- Comparator type explained most heterogeneity
Original publication
Effects of deep parasternal intercostal plane block on opioid consumption and pain after cardiac surgery: a meta-analysis of randomized controlled trials with meta-regression and trial sequential analysis. J Clin Anesth. Published 10 June 2026. doi:10.
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