Comparison of Different Thoracic Regional Anesthesia Techniques on the Analgesic Effect in Cardiac Surgery: A Randomized Controlled Trial

Objective To compare the analgesic effect and safety profiles of different thoracic regional anesthesia techniques for patients undergoing cardiac surgery. Method This is a prospective, randomized, interventional, controlled clinical trial (ChiCTR2400093387, December 03, 2024). Eighty-two patients undergoing cardiac surgery were randomized into four groups: the general anesthesia (GA) group (n = 20), the thoracic paravertebral nerve block (TPVB) group (n = 22), the erector spinae block (ESPB) group (n = 20), and the transversus thoracis muscle plane block (TTMPB) group (n = 20). Perioperative opioid consumption, pain scores, hemodynamic parameters, and the incidence of postoperative complications were collected. The primary endpoint was the perioperative opioids consumption. Results The intraoperative sufentanil consumption in TPVB group (GA vs. TPVB, 340.00 ± 50 µg vs. 214.55 ± 35 µg, p <0.001), ESPB group (GA vs. ESPB, 340.00 ± 50 µg vs. 248.00 ± 49 µg, p <0.001) and TTMPB group (GA vs. TTMPB, 340.00 ± 50 µg vs. 258.25 ± 78 µg, p  = 0.002) were significantly lower when compared to the GA group. The postoperative morphine consumption did not show significant difference within 24 and 48 hours after surgery. The Numeric Rating Scale (NRS, range 0–10) of the four groups of patients were similar within 24 hours after surgery, but the NRS in the ESPB group were significantly lower at 48 hours after surgery (GA vs. ESPB, 4(2) vs. 3(3), p  = 0.011) than those in the GA group. There was no statistical difference in mean arterial pressure (MAP) among groups, while the heart rate (HR) in the TPVB group was significantly lower than that in the other three groups at sternotomy (TPVB vs GA, 67.38 ± 12.32 bpm vs. 78.82 ± 16.65 bpm, p  = 0.005; TPVB vs ESPB, 67.38 ± 12.32 bpm vs. 74.22 ± 15.99 bpm, p  = 0.028; TPVB vs TTMPB, 67.38 ± 12.32 bpm vs. 78.10 ± 13.04 bpm, p  = 0.045). Conclusion TPVB, ESPB, and TTMPB significantly reduced intraoperative opioid consumption. TPVB was superior in terms of blunting surgical stimulation to the other two techniques.