Nerve blocks show modest but meaningful pain relief after cardiothoracic surgery

A large meta-analysis of 104 randomized controlled trials found that peripheral nerve blocks (PNBs) — specifically chest wall blocks and erector spinae plane blocks — are associated with modest reductions in postoperative pain and opioid use following cardiothoracic surgery. The analysis, published in the Journal of Cardiothoracic and Vascular Anesthesia, covered both open and minimally invasive cardiac and thoracic procedures in adults.

While the pain reductions were statistically meaningful, they fell below the 1.5-point threshold on a 0–10 scale considered the minimal clinically important difference. Still, researchers concluded that PNBs support a multimodal analgesia approach, with block selection tailored to patient factors and institutional expertise.

By the Numbers:

• 104 randomized controlled trials included (2013–2024)
• Erector spinae plane blocks reduced 24-hour pain scores by 0.82 points in minimally invasive thoracic surgery vs. no block
• Chest wall blocks reduced 24-hour pain by 0.77 points in minimally invasive thoracic surgery
• Minimal clinically important difference threshold: 1.5 points on a 0–10 pain scale
• Adverse events were rare and reported in only a subset of studies

Why it matters: With opioid-sparing strategies a top priority in surgical care, even modest benefits from nerve blocks could meaningfully improve patient recovery. These findings give clinicians evidence-backed guidance to incorporate PNBs into post-cardiothoracic surgery pain protocols — though better-quality trials are still needed.