Post by Regional Anesthesia and Pain Medicine

🫀Which regional analgesic technique offers the greatest benefit after cardiac surgery? This systematic review and Bayesian network meta-analysis synthesized evidence from 133 randomized trials involving 9,816 patients, comparing the most commonly used regional anesthesia techniques in adult cardiac surgery. 🪄 Key findings ✅ Intrathecal opioids (IT) produced the largest reduction in 24-hour opioid consumption (−14.8 MME) and the most consistent improvements in postoperative pain scores. ✅ ESPB and PIPB also reduced opioid consumption, but their effects were generally smaller than the predefined minimal clinically important difference. ✅ Thoracic epidural analgesia (TEA) was the only technique associated with a shorter hospital length of stay. ✅ No major block-related complications were reported across the included randomized trials. 💡 Why this matters This study goes beyond traditional pairwise meta-analyses by directly comparing multiple regional techniques within a single network. While fascial plane blocks continue to play an important role—particularly in patients who are not candidates for neuraxial analgesia—the current evidence suggests that intrathecal opioids remain the most effective regional analgesic strategy for cardiac surgery. ‼️ Importantly, the authors also emphasize that certainty of evidence ranged from moderate to low, with substantial clinical heterogeneity among studies. Therefore, technique selection should continue to consider patient characteristics, surgical factors, institutional expertise, and contraindications. ✨ The takeaway • First choice (when feasible): Intrathecal opioids • Excellent alternatives: ESPB and PIPB when neuraxial techniques are contraindicated • Remember: Statistical superiority does not always translate into large clinical differences. 🔗 Read the full study: https://lnkd.in/eMqMsxN4 #RegionalAnesthesia #CardiacAnesthesia #PainMedicine #RAPM