Breathe Easier: Evaluating Serratus Anterior Plane Block for Rib Fracture Analgesia-A Systematic Review and Meta-analysis
- 1Department of Anesthesiology and Reanimation, Universitas Airlangga-Dr. Soetomo General Academic Hospital Faculty of Medicine, Surabaya, Indonesia
- 2Department of Thoracic, Cardiac, and Vascular Surgery, Universitas Airlangga Faculty of Medicine, Surabaya, Indonesia
- 3Department of Anesthesiology and Intensive Care, Universitas Gadjah Mada Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
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.
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BibTeX
@article{alverina2026breathe,
title = {{Breathe Easier: Evaluating Serratus Anterior Plane Block for Rib Fracture Analgesia-A Systematic Review and Meta-analysis}},
author = {Clara Alverina and Safina Fairuz Salwaa and Syaogi Ahmed ‘Azizy and Pesta Parulian Maurid Edwar},
journal = {Thoracic Research and Practice},
year = {2026},
month = nov,
doi = {10.4274/thoracrespract.2026.2026-1-12},
url = {https://doi.org/10.4274/thoracrespract.2026.2026-1-12},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Breathe Easier: Evaluating Serratus Anterior Plane Block for Rib Fracture Analgesia-A Systematic Review and Meta-analysis
AU - Clara Alverina
AU - Safina Fairuz Salwaa
AU - Syaogi Ahmed ‘Azizy
AU - Pesta Parulian Maurid Edwar
PY - 2026
DA - 2026/11/03
JO - Thoracic Research and Practice
DO - 10.4274/thoracrespract.2026.2026-1-12
UR - https://doi.org/10.4274/thoracrespract.2026.2026-1-12
AB - 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.
SN - 2979-9139
ER -