Background and aim The objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on postoperative opioid consumption in patients undergoing open cardiac surgery. Methods This systematic review and network meta-analysis involved cardiac surgical patients (age >18 y) requiring median sternotomy. We searched PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The effects of the single-shot ultrasound-guided regional anesthesia technique were compared with those of placebo and no intervention. Results The primary outcome was opioid consumption during the first 24 h after surgery. The secondary outcomes were pain after extubation at 12 and 24 h, postoperative nausea and vomiting, extubation time, intensive care unit discharge time, and length of hospital stay. Fifteen studies with 849 patients were included. The regional anesthesia techniques included pecto-intercostal fascial block, transversus thoracis muscle plane block, erector spinae plane (ESP) block, and pectoralis nerve block I. All the regional anesthesia techniques included significantly reduced postoperative opioid consumption at 24 hours, expressed as morphine milligram equivalents (MME). The ESP block was the most effective treatment (-22.93 MME [-34.29;-11.56]). Conclusions In this meta-analysis, we concluded that fascial plane blocks were better than placebo when evaluating 24 hr MMEs. However, it is still challenging to determine which is better, given the paucity of studies available in the literature. More randomized controlled trials are required to determine which regional anesthesia technique is better.

Study Objective: The application of regional anesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective “motor sparing” analgesia technique used in knee surgeries. In this study, we aimed to evaluate the efficacy of two different concentrations of local anesthetic mixtures in terms of postoperative analgesia in patients undergoing knee arthroscopic intervention compared to each other and the control group. Design: Prospective, randomized, controlled, blinded Setting: Tertiary hospital Patients: A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 in each group. Interventions: Standardized postoperative analgesia was planned for all groups. In addition, ultrasound guided ACB (same volume / two different concentrations of bupivacaine-0.25% vs 0.16%) was applied to the experimental groups. Measurements: Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). Main Results: Tramadol requirement in the first 24 hours was significantly higher in the control group (209.5±23.27 mg),(p<0.001), and there was no difference between the experimental groups (63±42.06 mg vs 80.5±36.63 mg). Although the mean NRS score in the first three hours was higher in the control group than in both block groups, it was similar in all groups in the following measurements. Conclusion: In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics more than the control group.