Thoracic Ultrasound-Guided Regional Nerve Blockade for Pain Management Following Open Heart Surgery in Children: A Systematic Review and Network Meta-analysis of Analgesic Efficacy and Impact on Postoperative Opioid Requirements.

In 30 seconds

This systematic review and network meta-analysis compared single-shot ultrasound-guided regional nerve blocks used within multimodal analgesia for children undergoing open cardiac surgery through median sternotomy. It included 16 randomized clinical trials assessing 11 block techniques, with perioperative opioid consumption and postoperative pain scores as outcomes. Compared with no intervention, deep and superficial parasternal blocks reduced postoperative fentanyl consumption by -4.92 µg/kg (95% CI: [-6.58 to -3.26]) and -2.54 µg/kg (95% CI: [-4.16 to -0.91]), respectively; thoracic retrolaminar paravertebral block also reduced consumption. Estimates showed substantial heterogeneity.

Key findings

• Deep parasternal block reduced postoperative fentanyl consumption by -4.92 µg/kg (95% CI: [-6.58 to -3.26]) versus no intervention.
• Superficial parasternal block reduced postoperative fentanyl by -2.54 µg/kg (95% CI: [-4.16 to -0.91]) and intraoperative use by -5.12 µg/kg (95% CI: [-6.8 to -3.43]).
• Thoracic retrolaminar paravertebral block reduced postoperative fentanyl consumption by -5.6 µg/kg (95% CI: [-8.31 to -2.89]).
• Pooled estimates had substantial heterogeneity: I2 was 90.9% for intraoperative and 94.7% for postoperative fentanyl consumption.

Why it matters

Opioid-sparing analgesia is relevant in pediatric cardiac surgery, where pain control must be balanced against opioid exposure and associated adverse effects. The review suggests that block choice may matter: parasternal techniques showed opioid reductions, whereas several other blocks did not show significant postoperative opioid-sparing effects. The marked heterogeneity means these comparative estimates should be interpreted cautiously.

What to keep in mind

The pooled estimates showed substantial heterogeneity, limiting confidence in the consistency of effects across studies.