Efficacy of anterior serratus plane block and intercostal nerve block in cardiothoracic surgery: a meta-analysis

TL;DR

This study compares two pain management techniques in cardiothoracic surgery and finds they are similarly effective, though one may reduce opioid use.

Contribution

A meta-analysis comparing the analgesic efficacy of SAPB and INB in cardiothoracic surgery, focusing on opioid consumption and pain scores.

Findings

SAPB and INB show comparable pain relief and recovery outcomes in cardiothoracic surgery.

SAPB may reduce total opioid consumption compared to INB.

Subgroup analyses suggest SAPB could lower pain scores in thoracotomy procedures.

Abstract

This study aims to evaluate the differences in analgesic efficacy between the SAPB and INB in cardiothoracic surgery through a meta-analysis.

PubMed, Cochrane Library, Embase, and Web of Science were searched from the establishment of the databases until July 10, 2025. All randomized controlled trials (RCTs) comparing the efficacy of SAPB and INB in cardiothoracic surgery were included. Quality assessment was performed using risk of bias. All data were analyzed using Stata 15 software.

A total of 9 randomized controlled trials involving 606 patients were included, meta-analysis results indicated that no differences in 6-h pain scores [SMD = 0.28, 95% CI (−0.50, 1.06)], 12-h pain scores [SMD = −0.59, 95% CI (−1.71, 0.53)], 24-h pain scores [SMD = −0.07, 95% CI (−0.67, 0.52)], incidence of nausea and vomiting[RR = 0.84, 95% CI (0.27, 2.57)] and length of hospital stay [SMD = 0.01, 95% CI (−0.30, 0.32)]between the SAPB group and the INB group, However, compared with INB, SAPB may reduce total opioid consumption[SMD = −1.99, 95% CI (−3.21, −0.77)].

Overall, current evidence suggests that SAPB provides analgesic efficacy comparable to INB in cardiothoracic surgery. Subgroup analyses indicated that SAPB may be associated with lower pain scores in thoracotomy procedures and reduced opioid consumption in certain clinical settings; however, these findings should be interpreted cautiously due to heterogeneity across studies. Further high-quality randomized controlled trials are warranted to confirm these results.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251080642, PROSPERO CRD420251080642.

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