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Abstract
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Background and Aims Serratus anterior plane block (SAPB) is a popular technique for postoperative analgesia. However, the optimal approach (superficial vs. deep) remains unclear. This meta-analysis of randomized controlled trials (RCTs) aims to compare the analgesic efficacy between the two SAPB approaches to provide clinical guidance. (PROSPERO – CRD42023415415)
Methods PubMed, Embase and Cochrane were searched for RCTs comparing superficial and deep SAPB approaches. The outcomes included opioid consumption, pain scores, and postoperative nausea and vomiting (PONV) incidence. RevMan 5.4 analyzed data and sensitivity analysis was conducted by systematically removing each study.
Results The study analyzed five RCTs with 280 patients, 50% underwent superficial SAPB approach for mastectomy or thoracoscopic lobectomy. No significant differences were found in intravenous morphine equivalent consumption in 24 hours (figure 1); pain score at rest and movement at 1h (MD -0.02; 95% CI -0.30 to 0.27; p=0.91 and MD 0.14; 95% CI -0.80 to 1.08; p=0.77); 4h (MD -0.15; 95% CI -0.86 to 0.55; p=0.67 and MD -0.19; 95% CI -0.95 to 0.56; p=0.62); 12h (MD -0.05; 95% CI -0.63 to 0.52; p=0.85 and figure 3). Sensitivity analysis did not change the overall conclusion in any of the outcomes evaluated.
No differences were found between superficial and deep SAPB regarding opioid consumption in 24h (Results expressed in intravenous morphine equivalents)
Pain scores were similar for both approaches to the SAPB at 12h (A) and 24h (B) in movement
Incidence of PONV was similar both with superficial and deep SAPB approaches
Conclusions The results revealed no significant differences, suggesting that both approaches offer comparable pain relief benefits.