# Efficacy and Safety of Serratus Anterior Plane Block for Pain Management in Patients with Rib Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study finds that a regional anesthetic technique called SAPB reduces pain and opioid use in patients with rib fractures, but more research is needed to confirm its effectiveness.

## Contribution

The study provides a meta-analysis of randomized trials to evaluate the efficacy and safety of SAPB for rib fracture pain management.

## Key findings

- SAPB significantly reduced pain scores at 2, 6, 12, and 24 hours post-treatment.
- SAPB led to a significant reduction in 24-hour opioid consumption.
- No significant difference was found in the need for rescue analgesia between SAPB and standard care.

## Abstract

Background and Objectives: Rib fractures cause intense pain, leading to respiratory complications. Standard care relies on systemic opioids, which carry significant adverse effects. The serratus anterior plane block (SAPB) has emerged as a promising regional anesthetic technique, but its efficacy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of SAPB versus standard care in patients with rib fractures. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs comparing SAPB to standard care in adults with rib fractures. The primary outcome was the pain score. Secondary outcomes included 24 h opioid consumption, need for rescue analgesia, and complications. Standardized mean differences (SMD) and risk ratios (RR) were pooled, using STATA SE 19.5. Results: Three RCTs involving 310 patients were included. SAPB significantly decreased pain scores at 2 h (SMD: −1.30, 95% CI [−2.39, −0.20]; p = 0.02), 6 h (SMD: −0.75, 95% CI [−1.41, −0.09]; p = 0.03), 12 h (SMD: −0.37, 95% CI [−0.68, −0.07]; p = 0.02), and 24 h (SMD: −5.67, 95% CI [−9.90, −1.43]; p = 0.01). This was associated with a significant reduction in 24 h opioid consumption (SMD: −0.45, 95% CI [−0.69, −0.21]; p < 0.001). However, no significant differences were found in the need for rescue analgesia (RR: 1.06, 95% CI [0.97, 1.16]; p = 0.18). Conclusions: SAPB provides significant short-term analgesic benefits and reduces opioid consumption in patients with acute rib fractures. While it appears safe, the current evidence is limited by a small number of trials and is insufficient to recommend SAPB as a first-line management option over standard care.