Peripheral Regional Anesthetic Techniques in Cardiac Surgery: A Systematic Review and Meta-Analysis

Abstract

Objective(s)Aim of this systematic review was to investigate postoperative pain outcomes and adverse events following peripheral regional anesthesia (PRA) compared to no regional anesthesia (RA), placebo or neuraxial anesthesia in children and adults undergoing cardiac surgery. DesignSystematic review and meta-analysis with assessment of the risk of bias (Cochrane RoB 1) and certainty of evidence (GRADE). SettingRandomized controlled trials ParticipantsAdults and children undergoing heart surgery InterventionsAny kind of PRA compared to no RA or placebo or neuraxial anesthesia Measurements and Main resultsIn total 33 RCTs (2044 patients) – 24 of these had a high risk of bias and 28 were performed in adults - were included. PRA compared to no RA may reduce pain intensity at rest 24 h after surgery (MD -0.81 points, 95% CI -1.51 to -0.10; I2 = 92%; very low certainty evidence). PRA compared to placebo may reduce pain intensity at rest (MD -1.36 points, 95% CI -1.59 to -1.13; I2 = 54%; very low certainty evidence) and during movement (MD -1.00 points, 95% CI -1.34 to -0.67; I² = 72%; very low certainty evidence) 24 h after surgery. No data following pediatric cardiac surgery could be meta-analysed due to the low number of included trials. ConclusionsPRA compared to no RA or placebo may reduce pain intensity at rest and during movement. However, these results should be interpreted cautiously, because the certainty of evidence is only very low. Protocol registrationCRD42021223636