Efficacy of Serratus Anterior Plane Block vs Paravertebral and Intercostal Blocks for Pain Control after Surgery

Objective: Our study aims at comparing the analgesic efficacy of serratus anterior plane block (SAB) with the paravertebral block (PVB) and intercostal block (ICB) for patients undergoing surgical procedures. Material and methods: An extensive literature search was performed on the databases of ScienceDirect, Google Scholar, PubMed, and Embase from inception to 24 th October 2021. Only randomized controlled trials (RCTs) comparing SAB with either PVB or ICB and reporting pain outcomes were included. Results: 16 RCTs were included. 13 compared SAB with PVB and 3 with ICB. Comparing SAB with PVB, we noted no difference in 24-hour morphine consumption between the groups (MD: 1.37, 95% CI: -0.33, 3.08 I 2 =96%, P =0.11). However, the exclusion of one study indicated significantly increased analgesic consumption with the SAB. No difference was found in pain scores between SAB and PVB at 2, 4, 6, 8, 12, and 24 hours. Meta-analysis failed to demonstrate any statistically significant difference in time to first analgesic request (TFAR) between the two groups (MD: -0.79, 95% CI: -0.17, 1.75 I 2 =94%, P =0.11). We also noted no statistically significant difference in the incidence of nausea/vomiting with SAB or PVB (OR: 0.79, 95% CI: 0.41, 1.51 I 2 =0%, P =0.47). Conclusions: Evidence on the analgesic efficacy of the SAB vs. the PVB is conflicting. 24-hour total analgesic consumption (TAC) may be higher with the SAB as compared to PVB but with no difference in pain scores and TFAR. Data on the comparison of the SAB with the ICB is scarce to draw strong conclusions.