Purpose: To compare postoperative analgesic efficacy and opioid consumption between erector spinae plane block (ESPB) and continuous intercostal wound infiltration (IC-WI) in patients undergoing minimally invasive mitral valve surgery (MICS-MVR).

Patients and methods: In this retrospective registry study, patients undergoing MICS-MVR received either an ultrasound-guided ESPB at anesthesia induction or surgeon-administered continuous IC-WI at wound closure. All patients received standardized multimodal analgesia. The primary outcome was cumulative morphine consumption during the first 72 hours postoperatively. Secondary outcomes included pain during coughing assessed using the Numeric Rating Scale (NRS), extubation in the operating room, opioid-related adverse events, and early mobilization.

Results: A total of 221 patients were included in the analysis (ESPB: n = 113; IC-WI: n = 108). Mean cumulative morphine consumption over 72 hours did not differ significantly between groups (IC-WI: 151±10.3 mg vs. ESPB: 176±9.3 mg; p=0.07). Patients in the IC-WI group reported significantly lower NRS pain scores immediately after surgery compared with the ESPB group (3.1±0.3 vs. 4.3±0.3; p<0.003). Pain scores were comparable during the subsequent postoperative course. A significantly higher proportion of patients in the ESPB group were extubated in the operating room (37/113; p<0.001).

Conclusion: Ultrasound-guided ESPB provides postoperative analgesia almost comparable to IC-WI in patients undergoing MICS-MVR. ESPB was associated with lower intraoperative sufentanil requirements and a higher likelihood of immediate endotracheal extubation in the operating room. These findings support ESPB as an effective regional analgesic technique in minimally invasive cardiac surgery and as a potential component of Enhanced Recovery After Cardiac Surgery pathways.