Breathe Easier: Evaluating Serratus Anterior Plane Block for Rib Fracture Analgesia-A Systematic Review and Meta-analysis.

Abstract

Objective: Rib fractures may cause severe pain that impairs ventilation, increases pulmonary complications, and lengthens hospitalization. Conventional analgesic techniques have several limitations, whereas the serratus anterior plane block (SAPB) offers a simpler, ultrasound-guided regional anesthesia alternative. This systematic review and meta-analysis examined whether SAPB improves pain control and reduces opioid use and hospitalization duration.

Material and methods: A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed, Scopus, EBSCO, Taylor & Francis, Web of Science, and ScienceDirect was conducted to identify randomized and observational studies comparing SAPB with opioid-based analgesia or other regional blocks in patients with rib fracture pain. The primary outcome was pain severity visual analogue scale/numeric rating scale (VAS/NRS) at predefined time points, whereas opioid consumption and hospital length of stay (LOS) served as secondary outcomes. Given the variability of pain assessment scales across studies (NRS 0-10 and VAS 0-100), continuous outcomes were pooled as standardized mean differences (SMDs) using a random-effects model. Seven studies comprising 611 patients met the inclusion criteria and were included in the analysis.

Results: The meta-analysis showed that baseline pain scores were broadly comparable between SAPB and comparators, with no statistically significant difference overall (baseline SMD: 0.18; P = 0.25) or within either subgroup. Compared with opioids, SAPB was associated with significantly lower pain scores at 3 hours (SMD: -0.40; P = 0.04) and, in the opioid subgroup, at 12 hours (SMD: -0.44; P = 0.002). Overall pooled estimates at 6, 12, and 24 hours did not reach statistical significance owing to substantial heterogeneity (I² 87-96%). Compared with other regional blocks, SAPB was associated with higher pain scores at 6 hours (SMD: 0.85; P = 0.004), whereas the comparison at 24 hours was inconclusive, with the overall estimate not statistically significant (SMD: -0.76; P = 0.15). A pooled analysis also showed a significant reduction in opioid consumption with SAPB (SMD: -0.35; 95% confidence interval: -0.67 to -0.02; P = 0.04). Findings on hospital LOS were inconsistent across studies and remain inconclusive.

Conclusion: Overall, low-certainty evidence suggests that SAPB may provide effective and longer-lasting analgesia, reduce opioid requirements, and support respiratory function, indicating a potential role as an adjunct in the management of rib fracture pain.