{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T06:39:16Z","timestamp":1776321556973,"version":"3.50.1"},"reference-count":98,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48\u2005h both at rest and cough, decreased the rate of need for rescue analgesia (OR\u2009=\u20090.10, 95% CI: 0.016\u20130.55), shortened the time to tracheal extubation (MD\u2009=\u2009\u2212181.55, 95% CI: \u2212243.05 to \u2212121.33) and the duration of hospital stay (MD\u2009=\u2009\u22120.73, 95% CI: \u22121.22 to \u22120.24). Erector spinae plane block reduced the pain score 6\u2005h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12\u2005h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48\u2005h. Other outcomes were also similar among these regional anesthetic techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, ID: CRD42021276645<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1078756","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T04:32:24Z","timestamp":1684729944000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Ke","family":"Zhou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guang","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1097\/00000542-200610000-00026","article-title":"Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity","volume":"105","author":"Lahtinen","year":"2006","journal-title":"Anesthesiology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/AJP.0000000000000792","article-title":"Enhanced recovery after surgery (ERAS): a perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in the United States","volume":"36","author":"Echeverria-Villalobos","year":"2020","journal-title":"Clin J Pain"},{"key":"B3","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1097\/ACO.0000000000000769","article-title":"Regional anesthesia for cardiac surgery","volume":"32","author":"Caruso","year":"2019","journal-title":"Curr Opin Anaesthesiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1016\/j.ajic.2018.09.032","article-title":"Risk factors for ventilator-associated events: a prospective cohort study","volume":"47","author":"Liu","year":"2019","journal-title":"Am J Infect Control"},{"key":"B5","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12871-020-00961-8","article-title":"Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral\/tricuspid valve repair - a randomized controlled trial","volume":"20","author":"Gaweda","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.2147\/JPR.S313972","article-title":"The efficacy and safety of local anesthetic techniques for postoperative analgesia after cesarean section: a Bayesian network meta-analysis of randomized controlled trials","volume":"14","author":"Wang","year":"2021","journal-title":"J Pain Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s40122-014-0023-5","article-title":"A model-based meta-analysis to compare efficacy and tolerability of tramadol and tapentadol for the treatment of chronic non-malignant pain","volume":"3","author":"Mercier","year":"2014","journal-title":"Pain Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"110274","DOI":"10.1016\/j.jclinane.2021.110274","article-title":"Comparison of local and regional anesthesia modalities in breast surgery: a systematic review and network meta-analysis","volume":"72","author":"Wong","year":"2021","journal-title":"J Clin Anesth"},{"key":"B9","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/S0022-5223(19)37048-5","article-title":"Continuous epidural infusion of morphine for pain relief after cardiac operations","volume":"93","author":"El-Baz","year":"1987","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/j.1399-6576.1989.tb02865.x","article-title":"The influence of thoracic epidural analgesia on transcapillary fluid balance in subcutaneous tissue. 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