Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2025-01-01 Epub Date: 2024-10-15 DOI:10.1111/pan.15027

Rafael A Lombardi, Eduardo M Pereira, Sara Amaral, Heitor J S Medeiros, Walid Alrayashi

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引用次数: 0

Abstract

Introduction: 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.

Methods: 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.

Results: Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg^-1; 95% CI -3.15 to -0.66 μg.kg^-1; p = .003; I² = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I² = 0%). No significant differences were found in the remaining outcomes.

Conclusion: 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.

Prospero registration: CRD 42024526961.

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小儿心脏手术中脊柱后凸平面阻滞与静脉注射阿片类药物镇痛的比较：系统回顾和荟萃分析。

简介：竖脊肌平面阻滞（ESPB）是最近兴起的一种区域麻醉技术，用于小儿心脏手术围手术期的疼痛治疗。然而，将其与静脉注射阿片类药物镇痛效果进行比较的证据非常有限。我们旨在评估和比较ESPB与静脉注射阿片类药物在这种情况下的镇痛效果：我们系统地回顾并荟萃分析了在采用胸骨中线切开术的小儿心脏手术中比较ESPB与静脉注射阿片类药物镇痛的研究。主要结果是术中芬太尼用量和重症监护室（ICU）住院时间（LOS）。次要结果包括术后阿片类药物消耗量、首次抢救镇痛时间、疼痛评分、术后呕吐和其他并发症、拔管时间和住院时间。统计分析使用 RStudio 4.2.3 版本进行：5项研究共纳入384名患者，其中178名患者接受了ESPB治疗。ESPB明显减少了术中芬太尼的使用量（MD -1.90 μg.kg-1；95% CI -3.15 to -0.66 μg.kg-1；p = .003；I2 = 58%）和ICU LOS（MD -3.50 h；95% CI -4.32 to -2.69 h；p 2 = 0%）。其余结果无明显差异：我们的研究结果表明，ESPB可能是加强小儿心脏手术中线胸骨切开镇痛的重要辅助工具，有可能减少术中阿片类药物的需求和ICU LOS：CRD 42024526961。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.