Comparison of Regional Anesthetic Techniques for Postoperative Analgesia After Adult Cardiac Surgery: Bayesian Network Meta-analysis

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Jun 7

PMID 37283577

Authors

Ke Zhou

Dongyu Li

Guang Song

Affiliations

Soon will be listed here.

Abstract

Background: Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear.

Methods: Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality.

Results: This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques.

Conclusions: TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.

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References

Kumar K, Kalyane R, Singh N, Nagaraja P, Krishna M, Babu B . Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery. Ann Card Anaesth. 2018; 21(3):333-338. PMC: 6078028. DOI: 10.4103/aca.ACA_15_18. View

de Vries A, Mariani M, van der Maaten J, Loef B, Lip H . To ventilate or not after minimally invasive direct coronary artery bypass surgery: the role of epidural anesthesia. J Cardiothorac Vasc Anesth. 2002; 16(1):21-6. DOI: 10.1053/jcan.2002.29645. View

Mace L . An audit of post-operative nausea and vomiting, following cardiac surgery: scope of the problem. Nurs Crit Care. 2003; 8(5):187-96. DOI: 10.1046/j.1362-1017.2003.00029.x. View

Zawar B, Mehta Y, Juneja R, Arora D, Raizada A, Trehan N . Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients. Ann Card Anaesth. 2015; 18(3):385-91. PMC: 4881722. DOI: 10.4103/0971-9784.159810. View

El Shora H, El Beleehy A, Abdelwahab A, Ali G, Omran T, Hassan E . Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial. Thorac Cardiovasc Surg. 2018; 68(5):410-416. DOI: 10.1055/s-0038-1668496. View

Scott N, Turfrey D, Ray D, Nzewi O, Sutcliffe N, Lal A . A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg. 2001; 93(3):528-35. DOI: 10.1097/00000539-200109000-00003. View

Aydin M, Ahiskalioglu A, Ates I, Tor I, Borulu F, Erguney O . Efficacy of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Postoperative Opioid Consumption After Cardiac Surgery: A Prospective, Randomized, Double-Blind Study. J Cardiothorac Vasc Anesth. 2020; 34(11):2996-3003. DOI: 10.1053/j.jvca.2020.06.044. View

Albrecht E, Chin K . Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020; 75 Suppl 1:e101-e110. DOI: 10.1111/anae.14868. View

Zhan Y, Chen G, Huang J, Hou B, Liu W, Chen S . Effect of intercostal nerve block combined with general anesthesia on the stress response in patients undergoing minimally invasive mitral valve surgery. Exp Ther Med. 2017; 14(4):3259-3264. PMC: 5585755. DOI: 10.3892/etm.2017.4868. View

10.

Wong H, Pilling R, Young B, Owolabi A, Onwochei D, Desai N . Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis. J Clin Anesth. 2021; 72:110274. DOI: 10.1016/j.jclinane.2021.110274. View

11.

Guay J, Kopp S . Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database Syst Rev. 2019; 3:CD006715. PMC: 6396869. DOI: 10.1002/14651858.CD006715.pub3. View

12.

Athar M, Parveen S, Yadav M, Siddiqui O, Nasreen F, Ali S . A Randomized Double-Blind Controlled Trial to Assess the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2021; 35(12):3574-3580. DOI: 10.1053/j.jvca.2021.03.009. View

13.

Gaweda B, Borys M, Belina B, Bak J, Czuczwar M, Woloszczuk-Gebicka B . Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial. BMC Anesthesiol. 2020; 20(1):51. PMC: 7047405. DOI: 10.1186/s12871-020-00961-8. View

14.

Dogan Baki E, Ozturk N, Ayoglu R, Emmiler M, Karsli B, Uzel H . Effects of Parasternal Block on Acute and Chronic Pain in Patients Undergoing Coronary Artery Surgery. Semin Cardiothorac Vasc Anesth. 2015; 20(3):205-12. DOI: 10.1177/1089253215576756. View

15.

Bjornnes A, Rustoen T, Lie I, Watt-Watson J, Leegaard M . Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs. 2014; 15(1):47-54. DOI: 10.1177/1474515114550441. View

16.

Loick H, Schmidt C, Van Aken H, Junker R, Erren M, Berendes E . High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg. 1999; 88(4):701-9. DOI: 10.1097/00000539-199904000-00001. View

17.

Echeverria-Villalobos M, Stoicea N, Todeschini A, Fiorda-Diaz J, Uribe A, Weaver T . Enhanced Recovery After Surgery (ERAS): A Perspective Review of Postoperative Pain Management Under ERAS Pathways and Its Role on Opioid Crisis in the United States. Clin J Pain. 2019; 36(3):219-226. DOI: 10.1097/AJP.0000000000000792. View

18.

Sharma M, Mehta Y, Sawhney R, Vats M, Trehan N . Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery. Ann Card Anaesth. 2010; 13(1):28-33. DOI: 10.4103/0971-9784.58831. View

19.

Amat-Santos I, Dumont E, Villeneuve J, Doyle D, Rheault M, Lavigne D . Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation. Heart. 2012; 98(21):1583-90. DOI: 10.1136/heartjnl-2012-302185. View

20.

Kendall J, Russell G, Scawn N, Akrofi M, Cowan C, Fox M . A prospective, randomised, single-blind pilot study to determine the effect of anaesthetic technique on troponin T release after off-pump coronary artery surgery. Anaesthesia. 2004; 59(6):545-9. DOI: 10.1111/j.1365-2044.2004.03713.x. View