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

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.

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.

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.

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.