Abstract

Background: Adequate pain control during cardiac surgery is essential to attenuate hemodynamic stress responses and reduce opioid requirements. The erector spinae plane (ESP) block is a regional anesthesia technique with opioid-sparing potential; however, data from Vietnamese populations remain scarce. This study aimed to evaluate the intraoperative analgesic efficacy of the ESP block in cardiac surgery via median sternotomy, with intraoperative fentanyl consumption as the primary outcome and intraoperative hemodynamic changes as the secondary outcome.

Methods: A prospective, randomized controlled trial was conducted on 120 patients undergoing cardiac surgery at Hue Central Hospital (September 2025 – June 2026). Patients were randomly allocated to the ESP group (n = 60, bilateral ultrasound-guided catheter-based ESP block combined with general anesthesia) or the control group (n = 60, no ESP block; general anesthesia with postoperative intravenous morphine patient-controlled analgesia). The primary outcome was total intraoperative fentanyl consumption.

Results: Intraoperative fentanyl consumption was significantly lower in the ESP group compared with the control group (4.3 ± 0.7 vs. 5.8 ± 0.7 µg/kg; p < 0.001), representing a 26.7% reduction. This difference remained statistically significant after adjustment for age and operative time using multivariable linear regression. As secondary outcomes, hemodynamic parameters and anesthetic monitoring indices did not differ significantly between the two groups. The mean procedural time for ESP block placement was 12.6 ± 2.9 minutes, with no serious complications observed.

Conclusion: Ultrasound-guided catheter-based erector spinae plane block significantly reduces intraoperative fentanyl consumption in cardiac surgery via median sternotomy, with no serious complications observed. However, multicenter trials with larger samples are needed to confirm its safety and feasibility for routine clinical practice.