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Background <p>Serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) are widely used regional anesthesia techniques for postoperative analgesia and are generally considered safe and effective. However, the comparative efficacy remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB in adult patients undergoing thoracic and breast surgeries.</p> Methods <p>A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google Scholar up to February 28, 2025. Primary outcomes included time to first analgesic request (TFAR), 24-h total analgesic consumption (TAC) postoperatively, and 24-h postoperative pain scores at rest. Secondary outcomes comprised pain scores at various postoperative timepoints, intraoperative fentanyl consumption, length of hospital stay, patient satisfaction with analgesia, and incidence of complications. A random-effect model was applied for the meta-analysis.</p> Results <p>Twenty-eight 28 RCTs comprising 1796 patients were included. No significant differences were found between SAPB and TPVB in TFAR (mean difference [MD] = -0.68&#xa0;h, 95% confidence interval [CI]: -1.55 to 0.18, <i>P</i> = 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, <i>P</i> = 0.334), other postoperative pain scores, length of hospital stay, patient satisfaction, or incidence of postoperative nausea and vomiting (risk ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, <i>P</i> = 0.310). Despite statistically significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73&#xa0;mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, <i>P</i> = 0.005) did not exceed the minimal clinically important difference (MCID) of 10&#xa0;mg. SAPB also resulted in greater intraoperative fentanyl consumption (MD = 13.85 mcg, 95%CI: 3.86 to 23.84, <i>P</i> = 0.007) but a significantly lower incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, <i>P</i> = 0.006). Subgroup analyses showed that TPVB provided superior, but non-clinically significant, opioid-sparing benefits in thoracic procedures (3.38&#xa0;mg) and when compared to superficial SAPB (3.11&#xa0;mg).</p> Conclusion <p>SAPB offers comparable analgesic efficacy to TPVB, with a more favorable safety profile but slightly higher opioid consumption. However, the increased opioid use does not exceed the MCID. Therefore, SAPB is a clinically effective and safe alternative to TPVB for perioperative regional analgesia in thoracic and breast surgeries.</p>

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Comparison of perioperative analgesic efficacy between serratus anterior plane block and thoracic paravertebral block in adult patients undergoing thoracic and breast surgeries: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年10月14日

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  • Junxing Wang,
  • Ting Li

摘要

Background

Serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) are widely used regional anesthesia techniques for postoperative analgesia and are generally considered safe and effective. However, the comparative efficacy remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB in adult patients undergoing thoracic and breast surgeries.

Methods

A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google Scholar up to February 28, 2025. Primary outcomes included time to first analgesic request (TFAR), 24-h total analgesic consumption (TAC) postoperatively, and 24-h postoperative pain scores at rest. Secondary outcomes comprised pain scores at various postoperative timepoints, intraoperative fentanyl consumption, length of hospital stay, patient satisfaction with analgesia, and incidence of complications. A random-effect model was applied for the meta-analysis.

Results

Twenty-eight 28 RCTs comprising 1796 patients were included. No significant differences were found between SAPB and TPVB in TFAR (mean difference [MD] = -0.68 h, 95% confidence interval [CI]: -1.55 to 0.18, P = 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, P = 0.334), other postoperative pain scores, length of hospital stay, patient satisfaction, or incidence of postoperative nausea and vomiting (risk ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, P = 0.310). Despite statistically significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73 mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, P = 0.005) did not exceed the minimal clinically important difference (MCID) of 10 mg. SAPB also resulted in greater intraoperative fentanyl consumption (MD = 13.85 mcg, 95%CI: 3.86 to 23.84, P = 0.007) but a significantly lower incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, P = 0.006). Subgroup analyses showed that TPVB provided superior, but non-clinically significant, opioid-sparing benefits in thoracic procedures (3.38 mg) and when compared to superficial SAPB (3.11 mg).

Conclusion

SAPB offers comparable analgesic efficacy to TPVB, with a more favorable safety profile but slightly higher opioid consumption. However, the increased opioid use does not exceed the MCID. Therefore, SAPB is a clinically effective and safe alternative to TPVB for perioperative regional analgesia in thoracic and breast surgeries.