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: = 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.