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Minerva Anestesiologica 2022 September;88(9):719-28

DOI: 10.23736/S0375-9393.22.16272-3


language: English

Efficacy of ultrasound-guided parasternal block in adult cardiac surgery: a meta-analysis of randomized controlled trials

Jing LI 1, Lu LIN 2, Jian PENG 1, Shushao HE 1, Yan WEN 3, Ming ZHANG 4

1 Department of Anesthesiology, People’s Hospital of Yilong County, Nanchong, China; 2 Department of Anesthesiology, The General Hospital of Western Theater Command Hospital, Chengdu, China; 3 Department of Anesthesiology, Traditional Chinese Medicine Hospital of Nanchong, Nanchong, China; 4 Department of Neurology, People’s Hospital of Yilong County, Nanchong, China

INTRODUCTION: Pain after cardiac surgery is a common and severe postoperative complication. As a new regional nerve block method, ultrasound-guided parasternal block (PSB) has been increasingly used to supplement the analgesic effects of opioids in order to eliminate opioid-related adverse drug events, but its efficacy still remains controversial. In the present meta-analysis, we aim to screen all eligible randomized controlled trials (RCTs) and give a comprehensive summary of the clinical value of PSB after adult cardiac surgery.
EVIDENCE ACQUISITION: We searched all RCTs about PSB after cardiac surgery in the database of PubMed, Embase, Cochrane, CNKI and Wanfang with no limitation of language from inception to September 2021. Two reviewers were independently involved in the process of data extraction. Meta-analysis was performed by using Review Manager software. The quality of included RCTs were assessed by using Cochrane’s risk of bias assessment tool, and funnel plots were drawn to assess publication bias.
EVIDENCE SYNTHESIS: A total of 12 RCTs with 366 patients in PSB group and 364 patients in control group were included in the present meta-analysis. Pooled analysis revealed that intraoperative and postoperative consumption of sufentanil were significantly decreased with the addition of PSB (P<0.05). Numerical rating scale (NRS) scores in PSB group were found to be significantly lower than that of control group at extubation, postoperative 4 h and 8 h (P<0.05) instead of postoperative 24 h or longer. PSB could reduce the incidence of postoperative nausea and vomiting (PONV) (P<0.05). In addition, we demonstrated that PSB was significantly related to decreased mechanical ventilation time, total length of ICU stay and hospital days (P<0.05).
CONCLUSIONS: Through decreasing the consumption of opioids, ultrasound-guided PSB could relieve pain and limit opioid-related complications. Clinical outcomes, such as mechanical ventilation time, total length of ICU stay and hospital days, will also be improved. Our findings prove that ultrasound-guided PSB is an effective regional analgesic method after adult cardiac surgery.

KEY WORDS: Autonomic nerve block; Ultrasonography; Cardiac surgical procedures; Meta-analysis; Analgesia

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