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Original article
The serratus plane block for postoperative analgesia in breast and thoracic surgery: a systematic review and meta-analysis
  1. Matthew Chong1,
  2. Nicolas Berbenetz2,
  3. Kamal Kumar1 and
  4. Cheng Lin1
  1. 1 Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
  2. 2 Department of Medicine, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr Matthew Chong, Western University, London, ON N6A 3K7, Canada; matthew.a.chong{at}gmail.com

Abstract

Background and objectives The serratus plane block (SPB) is a novel chest wall interfascial plane block. Its analgesic efficacy compared with non-block care and paravertebral block (PVB) is unestablished.

Methods We conducted a random-effects meta-analysis of randomized controlled trials (RCTs) recruiting adult surgical patients that compared a SPB to non-block care or PVB for postoperative analgesia. Visual analog scale pain scores were the primary outcome. Database sources were Medline, Embase, the Cochrane Library, and Google Scholar searched up to July 29, 2019 without language restriction. Risk of bias was assessed using Cochrane methodology.

Results Nineteen RCTs that comprised 1260 patients were included. Six trials involved thoracic surgery patients and 13 studied breast surgery patients. SPB reduced pain scores 0 hour postoperatively (−1.62 cm; 99% CI −2.43 to −0.81; p<0.001; I2=92%), at 2–4 hours (−1.29 cm; 99% CI −2.08 to −0.49; p<0.001; I2=92%), at 6 hours (−1.69 cm; 99% CI −3.19 to −0.20; p=0.004; I2=99%), and up to 24 hours compared with non-block care. SPB also prolonged the time to first analgesic request (193.2 min; 95% CI 7.2 to 379.2 min; p=0.04; I2=99%), reduced 24-hour postoperative opioid consumption (−11.27 mg of IV morphine equivalent; −17.36 to −5.18 mg; p<0.001), and reduced postoperative nausea and vomiting (RR 0.51; 95% CI 0.38 to 0.68; p<0.001; I2=12%). In contrast, no meaningful differences were detected in any of the outcomes for the SPB versus PVB data.

Conclusions SPB reduced postoperative pain scores (Grading of Recommendations Assessment, Development, and Evaluation rating: low; due to heterogeneity and deficiencies in blinding) in breast and thoracic surgery patients compared with non-block care. Based on five trials only, SPB was not appreciably different from PVB.

  • truncal blocks
  • acute pain
  • postoperative pain

https://doi.org/10.1136/rapm-2019-100982

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    Footnotes

    • Contributors MC led the study team and conceived the idea for the systematic review and meta-analysis. He designed the search strategy, screened study articles, extracted data, performed the data analysis, interpreted the data, and wrote the final manuscript. NB assisted with the search strategy design, data extraction, and reviewed the final manuscript. KK helped conceive the idea for the meta-analysis, interpreted the data, and reviewed the final manuscript. CL assisted with the conception of the meta-analysis, screened study articles, interpreted the data, and helped draft and reviewed the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.