Impact of Erector Spinae Block on Postoperative Analgesia and Hospital Recovery in Coronary Artery Bypass Surgery: A Systematic Review with Meta-analysis, Meta-Regression, and Sequential Trial Analysis
- 1Federal University of Bahia, Salvador, Brazil
- 2Botucatu School of Medicine, Paulista State University, Botucatu, Brazil
Abstract
The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed. ESPB significantly reduced the morphine milligram equivalent consumption at 24 h (mean difference (MD) –19.05 mg; 95% confidence interval (CI) [–22.50 to –15.61]; P < 0.001; high certainty) and 48 h (MD –19.42 mg; 95% CI [–28.75 to –10.09]; P < 0.001; moderate certainty). Pain scores, by the Numerical Rating Scale, were lower within 12 h (MD –0.93; P < 0.001; moderate certainty) and at 24 h (MD –0.58; P = 0.016; low certainty). ESPB shortened extubation time (MD –2.50 h; high certainty) and ICU stay (MD –12.55 h; moderate certainty). TSA confirmed robust evidence for opioid reduction, early pain relief, and extubation benefits. ESPB provides effective early analgesia, reduces perioperative opioid requirements, and accelerates recovery in CABG, representing a fundamental complement to conventional isolated intravenous analgesia. Future research should investigate continuous techniques.
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BibTeX
@article{carvalho2026impact,
title = {{Impact of Erector Spinae Block on Postoperative Analgesia and Hospital Recovery in Coronary Artery Bypass Surgery: A Systematic Review with Meta-analysis, Meta-Regression, and Sequential Trial Analysis}},
author = {João Paulo Aureliano de Carvalho and Helen dos Reis Requião and Rodrigo Mascarenhas Vieira and Pablo de Sousa Ferreira and Elias Batista da Silva Neto and Liana Maria Tôrres de Araújo Azi and Norma Sueli Pinheiro Módolo and Rodrigo Leal Alves},
journal = {Annals of Cardiac Anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/aca.aca_17_26},
url = {https://doi.org/10.4103/aca.aca_17_26},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Impact of Erector Spinae Block on Postoperative Analgesia and Hospital Recovery in Coronary Artery Bypass Surgery: A Systematic Review with Meta-analysis, Meta-Regression, and Sequential Trial Analysis
AU - João Paulo Aureliano de Carvalho
AU - Helen dos Reis Requião
AU - Rodrigo Mascarenhas Vieira
AU - Pablo de Sousa Ferreira
AU - Elias Batista da Silva Neto
AU - Liana Maria Tôrres de Araújo Azi
AU - Norma Sueli Pinheiro Módolo
AU - Rodrigo Leal Alves
PY - 2026
DA - 2026/10/12
JO - Annals of Cardiac Anaesthesia
DO - 10.4103/aca.aca_17_26
UR - https://doi.org/10.4103/aca.aca_17_26
AB - The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed. ESPB significantly reduced the morphine milligram equivalent consumption at 24 h (mean difference (MD) –19.05 mg; 95% confidence interval (CI) [–22.50 to –15.61]; P < 0.001; high certainty) and 48 h (MD –19.42 mg; 95% CI [–28.75 to –10.09]; P < 0.001; moderate certainty). Pain scores, by the Numerical Rating Scale, were lower within 12 h (MD –0.93; P < 0.001; moderate certainty) and at 24 h (MD –0.58; P = 0.016; low certainty). ESPB shortened extubation time (MD –2.50 h; high certainty) and ICU stay (MD –12.55 h; moderate certainty). TSA confirmed robust evidence for opioid reduction, early pain relief, and extubation benefits. ESPB provides effective early analgesia, reduces perioperative opioid requirements, and accelerates recovery in CABG, representing a fundamental complement to conventional isolated intravenous analgesia. Future research should investigate continuous techniques.
SN - 0971-9784
SN - 0974-5181
ER -