Ultrasound-guided thoracic paravertebral block versus erector spinae plane block analgesia for cardiac surgery with median sternotomy: a noninferiority randomised controlled trial.

BACKGROUND

Effective postoperative analgesia after cardiac surgery with median sternotomy is essential to minimise complications and promote recovery. Bilateral thoracic paravertebral block (TPVB) is an established technique in cardiac surgery but carries potential risks. Erector spinae plane block (ESPB) could offer a simpler and safer alternative.

METHODS

In this prospective, patient- and assessor-blinded, noninferiority, randomised controlled trial, adults undergoing median sternotomy for planned cardiac surgery were allocated to receive ultrasound-guided single-shot ESPB or TPVB with 20 ml of ropivacaine 0.375% per side performed under general anaesthesia in the left lateral decubitus position. The primary outcome was pain during forced expiration, assessed using the numerical rating scale (NRS) at 6 h after surgery. Secondary outcomes included opioid consumption and block-related adverse events.

RESULTS

We enrolled 74 participants. At 6 h, mean (sd) NRS pain scores were 3.5 (2.6) for ESPB and 3.0 (2.1) for TPVB (95% confidence interval, -0.48 to 1.34). As the upper bound of the 95% confidence interval exceeded the predefined margin of 1 NRS point, noninferiority of ESPB could not be demonstrated. Opioid consumption, NRS pain scores at 24 and 48 h, and ICU or hospital length of stay were comparable between groups. ESPB participants experienced more intraoperative hypertension than TPVB participants. No serious block-related complications were observed.

CONCLUSIONS

ESPB did not demonstrate noninferiority to TPVB for early dynamic analgesia after median sternotomy.

CLINICAL TRIAL REGISTRATION: NCT04546113.