Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

Objective. Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery. Methods. A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations. Results. Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, −38.51 mg of oral morphine equivalent; 95% confidence interval (CI), −60.97 to −16.05; P < 0.01 ; I2 = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, −9.85 mg of oral morphine equivalent; 95% CI, −19.52 to −0.18; P = 0.05 ; I2 = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19–0.55; P < 0.05 ;I2 = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), −1.23; 95% CI, −2.00 to −0.45; I2 = 92%; 2 h: SMD, −0.71; 95% CI, −1.00 to −0.41; I2 = 48%; 4 h: SMD, −1.52; 95% CI, −2.77 to −0.27; I2 = 95%; 6 h: SMD, −0.80; 95% CI, −1.51 to −0.08; I2 = 81%; 8 h: SMD, −1.12; 95% CI, −1.98 to −0.27; I2 = 92%; 12 h: SMD, −0.78; 95% CI, −1.21 to −0.35; I2 = 83%; and 24 h: SMD, −0.71; 95% CI, −1.20 to −0.23; I2 = 87%; P < 0.05 for all). Conclusion. SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

“…The results also showed that SAPB can reduce postoperative pain scores and opioid consumption at 24 h after surgery, and reduce the incidence of PONV after surgery. Regarding breast surgery, a meta-analysis by Hu et al showed that SAPB can reduce opioid consumption, relieve pain after breast surgery, and decrease the incidence of PONV to a certain extent [53,59]. Although the above studies have shown that SAPB can produce certain analgesic effects in different types of surgery, due to the prevalence of thoracic and breast surgery and the high heterogeneity between studies, it is necessary to further consider the effect of SAPB on postoperative pain in different types of surgery.…”

Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature

“…The anesthetic diffuses throughout this potential space, anesthetizing the anterolateral thoracic cage and upper abdominal wall. Similar to PECS blocks, the SAPB is safe and effective for pain management after chest wall surgeries and lateral rib fractures [21,28,[59][60][61][62][63]. Other painful conditions that have been successfully managed with this block in the ED include chest wall burns, intractable pain from herpes zoster, and placement of chest tubes [22,63].…”

The effect of different nerve block strategies on the quality of post‐operative recovery in breast cancer patients: A randomized controlled study

“…Currently, there are various nerve block analgesia methods for post-operative patients who undergo breast removal (Hu et al, 2021). Paravertebral nerve block, serratus anterior plane block, modified serratus anterior plane block, pectoral nerve block I (Pecs I), modified pectoral nerve block II (Pecs II), transverse thoracic muscle plane blocks (TTMPB) and serratus-intercostal plane block (SIPB) can all be applied as post-operative analgesia for breast removal (Abdallah et al, 2021;Albi-Feldzer et al, 2021;Gabriel et al, 2021;Shi et al, 2021); they can all reduce post-operative pain in patients, decrease opioid consumption during and after surgery and enhance the quality of post-operative recovery to some extent (Albi-Feldzer et al, 2021;Hu et al, 2021;Mazzinari et al, 2019;Xiao et al, 2021). However, there is no conclusive evidence to prove the best nerve block analgesia method for breast cancer removal (Albi-Feldzer et al, 2021;Singh et al, 2022;Stokes et al, 2022), and the effect of different methods on the quality of post-operative recovery is unclear.…”