Introduction Severe post-sternotomy pain and the constraints of neuraxial techniques under anticoagulation highlight the need for opioid-sparing, feasible analgesia in adult cardiac surgery. The erector spinae plane (ESP) block—providing paravertebral spread with a favorable safety profile—may reduce pain and opioid consumption without compromising hemodynamic stability; here we assess its analgesic efficacy and perioperative safety.

Methods A systematic search of various databases was conducted for Randomized Controlled Studies (RCTs) on erector spinae plane (ESP) block up to August 2025. Meta-analysis was performed using Stata 18.0, and ROBS 2.0 assessed risk of bias.

Results A total of 2658 Studies were screened, out of which 24 RCTs were included in the meta-analysis. Total number of patients were 1687, out of which 1073 were male, 637 were female, average age was 55.72 ± 6.40 with average follow up hours were 44.75 ± 18.29. Total number of patients in treatment group were 856 and total number of patients in control group were 837. Resting VAS pain showed no difference at 0 h (MD −0.03, 95% CI −0.36 to 0.30) or 24 h (0.01, −0.32 to 0.34), a increase at 36 h (0.50, 0.08 to 0.92), and no difference at 72 h (0.27, −0.40 to 0.94). During coughing, VAS favored control at 0 h (0.76, 0.03 to 1.48), 24 h (1.12, 0.03 to 2.21), and 36 h (0.74, 0.06 to 1.43), but not 72 h (0.25, −0.82 to 1.32). Opioid use decreased at 36 h (−24.87, −34.27 to −15.48). Length of stay was unchanged (−0.21 days, −0.70 to 0.28). Adverse events did not differ. Risk of bias was low.

Conclusion The ESP block is a safe, feasible, opioid-sparing adjunct with overall comparable pain scores and no increase in complications, supporting its use in adult cardiac surgery.

The authors have declared no competing interest.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251124891

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