Background <p>Regional anesthesia techniques, including the serratus anterior plane block (SAPB), reduce postoperative pain after minimally invasive cardiac surgery. However, the evidence regarding its impact on transapical transcatheter aortic valve replacement (TA-TAVR) is limited, and data specifically exploring its effectiveness on patient-centric outcomes are lacking.</p> Methods <p>We conducted a single-center randomized controlled trial comparing the efficacy of ultrasound-guided SAPB with ropivacaine 0.5% (40&#xa0;ml) with no block for patients undergoing TA-TAVR. The primary outcome was 24-hour Quality of Recovery-40 (QoR-40) score. Secondary outcomes included QoR-40 at 48&#xa0;h, pain scores, opioid consumption, and complications.</p> Results <p>A total of 66 participants were included in the analysis. The median QoR-40 [IQR] at 24&#xa0;h was higher in SAPB group (<i>n</i> = 32) compared with the no block group (<i>n</i> = 34): 180.5 (171.25–183) VS 172 (165.25–179), <i>p</i> = 0.006. At 48&#xa0;h, scores were 185.5 (182–189) vs. 183.5 (178.5–187), <i>p</i> = 0.048. Although these differences were statistically significant, they did not reach the minimum clinically important difference (MCID) of 6.3. Early postoperative analgesia was superior in the SAPB group, with lower resting/coughing NRS scores at 6 and 12&#xa0;h (median difference 1, <i>P</i> &lt; 0.001). However, there were no intergroup differences in opioid consumption or the need for rescue analgesia.</p> Conclusions <p>As part of multimodal analgesia for TA-TAVR, SAPB improved early postoperative analgesia but did not enhance the multidimensional quality of early recovery, as measured by the QoR-40 score. Further studies are warranted.</p> Trial registration <p>ChiCTR2300068584. Registered 24 February 2023.&#xa0;<ExternalRef> <RefSource>https://www.chictr.org.cn/bin/project/edit? pid=184719</RefSource> <RefTarget Address="https://www.chictr.org.cn/bin/project/edit? pid=184719" TargetType="Other" /> </ExternalRef>.</p>