Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis

Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries. Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I2 statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations. Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p < 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p < 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias. ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.