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Superficial parasternal intercostal plane block reduces 24-hour morphine use by 8.53 mg in cardiac surgery patientsS-PIP block lowers pain and opioid needs for adult heart surgery patients in this review

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Key Takeaway
Consider S-PIP block for modest early analgesia but note reduction below minimal clinically important difference.

This meta-analysis examined the superficial parasternal intercostal plane (S-PIP) block compared to standard or placebo analgesia in adult cardiac surgery patients. The analysis included 1760 participants and assessed outcomes over a 24-hour follow-up period. The primary outcome was 24-hour opioid use measured in morphine milligram equivalents. Secondary outcomes included early pain scores, rescue analgesic use, extubation time, intensive care unit stay, hospital stay, postoperative nausea and vomiting, and chronic postsurgical pain.

The pooled results indicated a significantly reduced mean difference of -8.53 mg for 24-hour opioid use with a 95% CI of -14.39 to -2.68. Early pain scores were lowered and rescue analgesic use was reduced. Extubation time and intensive care unit stay were also shortened. However, no meaningful differences were observed for hospital stay, postoperative nausea and vomiting, or chronic postsurgical pain.

The authors note that the reduction in opioid use was below the minimal clinically important difference. Substantial heterogeneity with an I-squared of 98.1% was present. Trial sequential analysis indicated the required sample size was not achieved. Consequently, the certainty of the evidence ranged from moderate to very low. Further high-quality multicenter trials are required to clarify the overall clinical value of this intervention.

This study looked at how a specific nerve block called S-PIP helps patients after heart surgery. It combined data from many smaller studies involving about seventeen hundred adults. The main goal was to see if this block could lower the amount of pain medicine needed in the first twenty-four hours.

The results showed that patients using the S-PIP block used less morphine and reported less pain early on. They also needed fewer extra pain medications and spent less time in the intensive care unit. The block helped with breathing recovery, allowing doctors to remove breathing tubes faster.

However, the study found no big changes in how long patients stayed in the hospital overall. There were also no differences in nausea, vomiting, or long-term pain after the surgery healed. The experts noted that the pain reduction was small and might not be enough to matter for most patients.

What this means for you:
S-PIP blocks help with early pain and opioid use after heart surgery but do not shorten hospital stays or prevent long-term pain.

Study Details

Study typeMeta analysis
Sample sizen = 1,760
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Effective postoperative pain control is essential for enhanced recovery after cardiac surgery, yet optimal multimodal strategies continue to evolve. The superficial parasternal intercostal plane (S-PIP) block has been proposed as a simple and safe technique for median sternotomy analgesia; however, current evidence remains fragmented, and its clinical impact is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials assessing the analgesic efficacy and safety of the S-PIP block in adult cardiac surgery. PubMed, Embase, CENTRAL, Web of Science, Scopus, ClinicalTrials.gov, and gray literature were searched through September 2025. Trials comparing S-PIP with standard or placebo analgesia were pooled using a random-effects model. The primary outcome was 24-hour opioid use (morphine milligram equivalents). Trial sequential analysis, meta-regression, and Grades of Recommendation, Assessment, Development, and Evaluation were applied to evaluate the robustness and certainty of evidence. RESULTS: Twenty-seven randomized controlled trials (1,760 patients) met the inclusion criteria. S-PIP block significantly reduced 24-hour opioid use compared with control (mean difference, -8.53 mg; 95% CI, -14.39 to -2.68), although the reduction was below the minimal clinically important difference and demonstrated substantial heterogeneity (I = 98.1%). Trial sequential analysis confirmed statistical significance, but the required sample size was not achieved. The block also lowered early pain scores, reduced rescue analgesic use, and shortened extubation time and intensive care unit stay. No meaningful differences were observed in hospital stay, postoperative nausea and vomiting, or chronic postsurgical pain. The certainty of the evidence ranged from moderate to very low. CONCLUSION: S-PIP provides modest early analgesic benefits after cardiac surgery. Further high-quality multicenter trials are required to clarify its overall clinical value.
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