Erector spinae plane and superficial parasternal intercostal plane blocks vs. control for sternotomy in cardiac surgery: A prospective, randomized trial

BACKGROUND: Cardiac surgical pain is challenging to treat because of its multifactorial nature. Fascial plane blocks present an attractive alternative analgesic technique due to their favorable safety profile and relative technical simplicity. METHODS: This prospective, randomized controlled trial tested the hypothesis that fascial plane blocks added to a multimodal analgesic regimen in patients undergoing cardiac surgery will decrease opioid consumption and pain scores postoperatively. Participants included adults of all genders between the ages of 18-85 who were assigned to American Society of Anesthesiologists physical status II-IV and underwent elective sternotomy procedures at Mount Sinai Morningside Hospital Center. Patients were randomized 1:1:1 to standard therapy, erector spinae plane block, or superficial parasternal intercostal plane block. Outcomes included the use of postoperative opioid medications in morphine equivalents, numerical rating scale pain scores, intensive care unit length of stay, hospital length of stay and postoperative nausea. RESULTS: A total of 271 patients were enrolled into the trial between July 2022 and July 2024. There was no significant difference in opioid consumption during the surgery and on postoperative days 0, 1, and 2, although the median morphine milligram equivalents use on postoperative day 3 was significantly different among the three groups driven by lower consumption in the ESP group, (p = 0.047). Maximum numerical pain rating scale was significantly lower in both regional block groups compared to control for postoperative day 0, 1, 2, and 3: POD 1 (p < 0.001), POD 2 (p < 0.001), and POD 3 (p = 0.002). CONCLUSION: Patients undergoing sternotomy procedures may benefit from the addition of erector spinae plane or superficial parasternal intercostal plane blocks to a postoperative multimodal analgesic regimen.