Opioid-Sparing Effects of Erector Spinae Plane Block in Off-Pump Coronary Artery Bypass Grafting with Median Sternotomy: A Randomized Controlled Trial.

Objective: This study assessed the efficacy of preoperative erector spinae plane block (ESPB) in reducing intraoperative opioid use and enhancing recovery in off-pump coronary artery bypass grafting (OPCABG) patients, who typically require high-dose opioids with associated postoperative risks. Methods: A prospective, double-blind randomized controlled trial was conducted on 37 patients. Patients were randomized to receive either bilateral ESPB with 0.375% ropivacaine or a sham block with normal saline. Primary outcomes included intraoperative sufentanil consumption, while secondary outcomes encompassed hemodynamic stability, postoperative pain scores, mechanical ventilation (MV) duration, and hospital stay. Results: The ESPB group demonstrated a significant reduction in intraoperative sufentanil consumption compared to the sham group (150.3 ± 36.1 µg vs. 194.4 ± 38.3 µg, p = 0.001). Postoperatively, ESPB patients exhibited lower pain scores at rest and during coughing within the first 6 h post-extubation (p < 0.001) and required less rescue analgesia (5.3% vs. 50.0%, p = 0.003). Additionally, ESPB shortened MV duration (5.43 ± 1.65 h vs. 6.88 ± 1.68 h, p = 0.013). No significant differences were observed in cardiac care unit or hospital stay lengths. Conclusions: Preoperative ESPB effectively reduces intraoperative opioid requirements and provides sustained analgesia in the early postoperative period, facilitating earlier extubation. These findings support ESPB as a valuable component of multimodal analgesia in OPCABG, though further large-scale studies are needed to validate these results and optimize its application.

Background: The trial was registered with the China Clinical Trials Center ( http://www.chictr.org.cn , ChiCTR2200066902) on December 21, 2022.