Erector spinae plane and superficial parasternal intercostal plane blocks vs. control for sternotomy in cardiac surgery: A prospective, randomized trial
In brief
Nerve plane blocks lower pain scores for four days after sternotomy
In this randomized trial of 271 cardiac surgery patients, both erector spinae and superficial parasternal blocks were linked to lower peak pain scores than standard care on postoperative days 0 through 3. Opioid use was similar across groups on most days, with lower use in the erector spinae group on day 3; whether the pain benefit improves recovery remains unclear.
- Journal
- Journal of clinical anesthesia (Q1)
- Published
- 7 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ali Shariat, Natalia Egorova, Yuxia Ouyang, Shenghao Fang, Eleonora Koshchak, Daniel Qian, et al.
- PMID
- 42843238
- DOI
- 10.1016/j.jclinane.2026.112330
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 11 October 2026): ESP and parasternal blocks for sternotomy
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.