Analgesic Efficacy and Perioperative Safety of the Erector Spinae Plane Block in Adult Cardiac Surgery

IntroductionSevere post-sternotomy pain and the constraints of neuraxial techniques under anticoagulation highlight the need for opioid-sparing, feasible analgesia in adult cardiac surgery. The erector spinae plane (ESP) block--providing paravertebral spread with a favorable safety profile--may reduce pain and opioid consumption without compromising hemodynamic stability; here we assess its analgesic efficacy and perioperative safety. MethodsA systematic search of various databases was conducted for Randomized Controlled Studies (RCTs) on erector spinae plane (ESP) block up to August 2025. Meta-analysis was performed using Stata 18.0, and ROBS 2.0 assessed risk of bias. ResultsA total of 2658 Studies were screened, out of which 24 RCTs were included in the meta-analysis. Total number of patients were 1687, out of which 1073 were male, 637 were female, average age was 55.72 {+/-} 6.40 with average follow up hours were 44.75 {+/-} 18.29. Total number of patients in treatment group were 856 and total number of patients in control group were 837. Resting VAS pain showed no difference at 0 h (MD -0.03, 95% CI -0.36 to 0.30) or 24 h (0.01, -0.32 to 0.34), a increase at 36 h (0.50, 0.08 to 0.92), and no difference at 72 h (0.27, -0.40 to 0.94). During coughing, VAS favored control at 0 h (0.76, 0.03 to 1.48), 24 h (1.12, 0.03 to 2.21), and 36 h (0.74, 0.06 to 1.43), but not 72 h (0.25, -0.82 to 1.32). Opioid use decreased at 36 h (-24.87, -34.27 to -15.48). Length of stay was unchanged (-0.21 days, -0.70 to 0.28). Adverse events did not differ. Risk of bias was low. ConclusionThe ESP block is a safe, feasible, opioid-sparing adjunct with overall comparable pain scores and no increase in complications, supporting its use in adult cardiac surgery.