Abstract

Introduction: Regional anaesthesia (RA) is an established option for analgesia in cardiac surgery performed via median sternotomy. Despite the growth of minimally invasive approaches, sternotomy remains widely used and is associated with substantial postoperative pain and related complications. Perioperative analgesic management in cardiac surgery is therefore typically multimodal. The primary objective of this study was to evaluate the efficacy and limitations of RA techniques to determine whether RA could serve as a core component of postoperative pain management after sternotomy.

Methods: We conducted a systematic review of the literature across multiple databases to identify studies reporting postoperative outcomes of RA techniques with respect to reduction of post-sternotomy pain. Six studies in which the primary endpoint was postoperative pain after cardiac surgery met the eligibility criteria and were included in the meta-analysis.

Results: Pooled analysis of the six studies indicated that RA was associated with a clinically meaningful reduction in post-sternotomy pain intensity (pooled mean difference approximately −3 points on a 0–10 scale), along with decreased opioid consumption. Considerable between-study heterogeneity was observed (I² = 99.5%), reflecting variation in RA techniques, comparators, and perioperative protocols; nevertheless, the direction of effect consistently favoured RA.

Conclusion: RA appears effective for improving postoperative analgesia after cardiac surgery via median sternotomy and may reduce perioperative opioid requirements. Incorporation of RA into Enhanced Recovery After Cardiac Surgery pathways could support postoperative recovery and mitigate opioid-related adverse effects. Given the substantial heterogeneity across studies, further well-designed trials using standardised analgesic outcomes are warranted to refine indications and optimise technique selection.