Comparing ultrasound-guided serratus anterior plane block with erector spinae plane block for postoperative analgesia in thoracic and breast surgery: A systematic review and meta-analysis

Abstract

Background: Serratus anterior plane block (SAPB) was first proposed in 2013 as a new method for regional nerve block, while erector spinae plane block (ESPB) was first proposed in 2016. Both regional nerve block techniques can be used for analgesia in thoracic and breast surgery, but the debate about their actual effects continues. The purpose of this systematic review was to compare the analgesic effects of these two nerve block techniques after thoracic and breast surgery. Methods: We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases up to August 2022. We performed a meta-analysis of clinical randomized controlled trials (RCTs) comparing the effects of SAPB and ESPB on postoperative analgesia in patients undergoing thoracic and breast surgery. Results: A total of 11 RCTs were included. Meta-analysis revealed that compared with the SAPB group, patients in the ESPB group had significantly reduced 24-hour postoperative opioid consumption (standardized mean difference [SMD]: -0.76; 95% confidence interval [CI]: -1.29 to -0.24; P < 0.01; I2=88%). Rest or movement pain scores were significantly lower at various time points postoperatively. In addition, ESPB-group patients had significantly reduced intraoperative opioid consumption (SMD: -0.43; 95% CI: -0.64 to -0.23; P<0.001; I2=35%). In terms of time to first use of analgesics, ESPB significantly prolonged the time to first analgesic use (SMD: 3.53; 95% CI: 1.62 to 5.44; P < 0.001; I2 = 97%). Conclusions: Compared with SAPB, ESPB is more effective in analgesia after thoracic and breast surgery, especially in thoracic surgery.