{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:30:54Z","timestamp":1791869454360,"version":"4.3.4"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims:<\/jats:title>\n Intrathecal morphine (ITM) and erector spinae plane block (ESPB) decrease postoperative pain in standard cardiac surgery. In this study, we compared the analgesic efficacy of ITM and B\/L ESPB in patients undergoing open heart surgeries.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n After approval from the institutional ethics committee and written informed consent from patients scheduled for open heart surgeries, they were randomized into two groups: Group ITM patients received ITM (5 mcg\/kg), whereas Group ESPB patients received bilateral ESP block (0.3 mL\/kg of 0.5% ropivacaine on either side). The primary outcome was to compare postoperative fentanyl consumption during the first 24 hours of ICU stay after extubation. Secondary outcomes were postoperative VAS at rest and on cough during the first 24 hours, pre- and postoperative pulmonary function, and number of rescue analgesics. Quantitative variables were presented as mean (SD) or median (IQR). Categorical variables were expressed as numbers or percentages. Spirometry variables were compared over time between the groups using Friedman test.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n The ITM group had significantly less median fentanyl consumption compared to the ESPB group during the first 24 hours postoperative period [0 (0\u201375) \u03bcg vs. 234 (160\u2013336) \u03bcg (95% CI, 171.65, 255.38); P < 0.001]. The VAS score at rest and during cough was significantly better in the ITM group. FEV1 and FVC reduced postoperatively in both groups with significantly better values in the ITM group.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n ITM administered prior to induction provides superior postoperative analgesia compared to bilateral ESPB in patients undergoing open-heart surgery. It significantly reduces opioid requirements, improves patient satisfaction, and enhances postoperative pulmonary function.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aca.aca_302_25","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:00:15Z","timestamp":1776171615000},"page":"212-218","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Analgesic Efficacy of Intrathecal Morphine and Ultrasound-Guided Bilateral Erector Spinae Plane Block in Patients Undergoing Open Heart Surgery with Midline Sternotomy: An Open Label Randomized Control Trial"],"prefix":"10.4103","volume":"29","author":[{"given":"Visalatchi","family":"Karuppiah","sequence":"first","affiliation":[{"name":"Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadik","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Chouan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260415","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1378\/chest.118.2.391","article-title":"Pain location, distribution, and intensity after cardiac surgery","volume":"118","author":"Mueller","year":"2000","journal-title":"Chest"},{"key":"R2-20260415","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1053\/j.jvca.2018.11.021","article-title":"Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery-A patient-matched, controlled before-and-after study","volume":"33","author":"Macaire","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R3-20260415","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1345\/aph.1H386","article-title":"Opioid-related adverse drug events in surgical hospitalizations: Impact on costs and length of stay","volume":"41","author":"Oderda","year":"2007","journal-title":"Ann Pharmacother"},{"key":"R4-20260415","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/ALN.0b013e31823c1030","article-title":"Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management","volume":"116","year":"2012","journal-title":"Anesthesiology"},{"key":"R5-20260415","doi-asserted-by":"crossref","first-page":"2760","DOI":"10.1053\/j.jvca.2018.01.045","article-title":"Enhanced recovery for cardiac surgery","volume":"32","author":"Noss","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R6-20260415","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.bpa.2019.07.008","article-title":"Regional anesthesia considerations for cardiac surgery","volume":"33","author":"Liu","year":"2019","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"R7-20260415","first-page":"405","article-title":"Intrathecal morphine improves hemodynamic parameters and analgesia in patients undergoing aortic valve replacement surgery: A prospective, double-blind, randomized trial","volume":"20","author":"Elgendy","year":"2017","journal-title":"Pain Physician"},{"key":"R8-20260415","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1590\/S1807-59322009000400003","article-title":"Intrathecal morphine plus general anesthesia in cardiac surgery: Effects on pulmonary function, postoperative analgesia, and plasma morphine concentration","volume":"64","author":"dos Santos","year":"2009","journal-title":"Clinics (Sao Paulo)"},{"key":"R9-20260415","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/AAP.0000000000000451","article-title":"The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain","volume":"41","author":"Forero","year":"2016","journal-title":"Reg Anesth Pain Med"},{"key":"R10-20260415","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1749-8090-9-52","article-title":"Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial","volume":"9","author":"Rafiq","year":"2014","journal-title":"J Cardiothorac Surg"},{"key":"R11-20260415","doi-asserted-by":"crossref","first-page":"228","DOI":"10.4103\/aca.aca_215_24","article-title":"Multimodal analgesia in cardiothoracic procedure: Opioid and non-opioid pharmacology for pain management: Part 1","volume":"28","author":"Bhatt","year":"2025","journal-title":"Ann Card Anaesth"},{"key":"R12-20260415","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1053\/j.jvca.2018.09.017","article-title":"Regional techniques for cardiac and cardiac-related procedures","volume":"33","author":"Mittnacht","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R13-20260415","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/ACO.0000000000000818","article-title":"St Vincent's Hospital Melbourne. Ultrasound-guided blocks for cardiovascular surgery: Which block for which patient?","volume":"33","author":"Smith","year":"2020","journal-title":"Curr Opin Anaesthesiol"},{"key":"R14-20260415","first-page":"848","article-title":"Low-dose intrathecal morphine does not delay early extubation after cardiac surgery","volume":"52","author":"Jacobsohn","year":"2005","journal-title":"Can J Anaesth"},{"key":"R15-20260415","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/ALN.0000000000003963","article-title":"Intrathecal morphine for analgesia in minimally invasive cardiac surgery: A randomized, placebo-controlled, double-blinded clinical trial","volume":"135","author":"Dhawan","year":"2021","journal-title":"Anesthesiology"},{"key":"R16-20260415","doi-asserted-by":"crossref","first-page":"E205","DOI":"10.1532\/HSF98.20033014","article-title":"Spinal (subarachnoid) morphine for off-pump coronary artery bypass surgery","volume":"7","author":"Mehta","year":"2004","journal-title":"Heart Surg Forum"},{"key":"R17-20260415","doi-asserted-by":"crossref","first-page":"110479","DOI":"10.1016\/j.jclinane.2021.110479","article-title":"Bilateral continuous erector spinae plane block using a programmed intermittent bolus regimen versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: A randomized controlled trial","volume":"75","author":"Kang","year":"2021","journal-title":"J Clin Anesth"},{"key":"R18-20260415","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12871-017-0398-z","article-title":"Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: A single center propensity-matched cohort study","volume":"17","author":"Ellenberger","year":"2017","journal-title":"BMC Anesthesiol"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_302_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:55:11Z","timestamp":1786647311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_302_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_302_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-05","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}