The effect of postoperative serratus anterior plane block on postoperative analgesia in patients undergoing breast surgery

Aslan, Gökhan; Avcı, Onur; Gündoğdu, Oğuz; İşbir, Ahmet Cemil; Kol, İclal Özdemir; Kaygusuz, Kenan; Gürsoy, Sinan

doi:10.47717/turkjsurg.2020.4744

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…The years of publication of these studies ranged from 2017 to 2021, and the sample size ranged from 40 to 116. Overall, 7 trials, 5 trials, and 1 trial used bupivacaine [ 26 , 27 , 30 , 32 , 34 , 36 ], ropivacaine [ 12 , 29 , 33 , 35 , 37 ], and levobupivacaine [ 28 ] as a local anaesthetic, respectively. The volume of the local anaesthetic was 20–40 mL, and its concentration was 0.25%–0.5%.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 10 trials used the random sequence generation method [ 12 , 27 – 37 ], 9 trials explained the allocation concealment [ 12 , 26 , 28 , 30 , 33 , 35 , 36 ], 3 trials explicitly described the method of double blinding [ 12 , 28 , 36 ], and 9 trials described blinded assessors and evaluated attrition bias [ 12 , 27 , 28 , 31 , 33 – 37 ]. There was no selective reporting.…”

Section: Resultsmentioning

confidence: 99%

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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

Lü

et al. 2021

Pain Research and Management

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Lü

et al. 2021

Pain Research and Management

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“…In terms of participant and personnel blinding, 3 studies were not blinded [30,34,50], and 13 were not described [4, 16, 32, 37-42, 44, 45, 49, 52]. Among the result-blinding methods, one item was not blinded [49], and 7 studies did not specify whether they have blinded [16,30,32,38,45,47,49]. All studies were not selectively reported.…”

Section: Assessment Of Methodological Qualitymentioning

confidence: 99%

“…Nineteen studies reported 24 h postoperative opioid consumption in patients undergoing thoracic or breast surgery [5,15,16,32,33,[36][37][38][45][46][47][48]. Meta-analysis showed that SAPB significantly reduced 24 h postoperative opioid consumption compared with the control group (Figure 8) (SMD, −2.77; 95% CI, −3.56 to −1.97; P < 0.01; I 2 = 97%).…”

Section: Postoperative Opioid Consumption At Hmentioning

confidence: 99%

“…Thirteen studies including 781 patients [14,31,32,34,36,38,39,42,[44][45][46][47]52] reported the number of patients who required emergency additional analgesia after surgery for thoracic or breast surgery. Meta-analysis showed that SAPB significantly reduced the number of patients requiring rescue analgesia compared with the control group (Supplementary Figure 2) (RR, 0.34; 95% CI, 0.27 to 0.42; P < 0.01; I 2 = 0).…”

Section: Number Of Patients Requiring Urgent Additional Analgesia Aft...mentioning

confidence: 99%

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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

Zhang¹,

Wu²,

Liu³

et al. 2022

Front. Anesthesiol.

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ObjectiveSerratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery.MethodsWe systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score.ResultsA total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P < 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P < 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI,0.27 to 0.42; P < 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P < 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P < 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P < 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P < 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P < 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P < 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months.ConclusionsCompared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioids and shortens the length of hospital stay. SAPB can be used as a feasible technique for multimodal analgesia in the perioperative period.

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Analgaesic efficacy of single-injection serratus anterior plane block for breast surgery: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials

Makkar¹,

Singh²,

Bhat³

et al. 2023

Indian J Anaesth

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There is conflicting evidence regarding the analgaesic efficacy of single-shot serratus anterior plane block (SAP) for breast surgery. This meta-analysis aimed to evaluate the analgaesic efficacy of SAP compared with non-block care (NBC) and other regional blocks, i.e. paravertebral block (PVB) and modified pectoral nerve block (PECS block) for breast surgery. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomized controlled trials reporting the use of the SAP block in adult breast surgery. The primary outcome was postoperative oral morphine equivalent (OME) consumption for up to 24 hours. Random-effects models were used to pool results and mean difference (MD), and odds ratio (OR) was calculated for continuous and dichotomous outcomes, respectively. GRADE guidelines were used to evaluate the strength of evidence, and trial sequential analysis (TSA) was performed to provide certainty to the conclusion. Twenty-four trials enrolling 1789 patients were included. Moderate strength evidence suggested that SAP provided a significant reduction in 24-hour OME compared with NBC [MD − 24.9 mg (95% CI − 41.54, −8.25; P < 0.001, I 2 = 99.68%)]. TSA ruled out the possibility of false-positive results. Subgroup analysis for the SAP demonstrated that the superficial plane approach was more effective in reducing opioid consumption than the deep approach. The odds of developing PONV were significantly lower in SAP compared to NBC. Compared with PVB and PECS, SAP block was not statistically different for 24-hour OME and time to first rescue analgaesia. Single-shot SAP reduced opioid consumption, prolonged analgaesia duration, lowered pain scores, and decreased the incidence of PONV compared to NBC. There was no statistically significant difference in the studied endpoints between SAP, PVB, and PECS blocks.

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The effect of postoperative serratus anterior plane block on postoperative analgesia in patients undergoing breast surgery

Cited by 3 publications

References 12 publications

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

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

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

Analgaesic efficacy of single-injection serratus anterior plane block for breast surgery: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials

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