ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Comparison of the postoperative analgesic efficacy of serratus anterior plane block with different types of blocks for video-assisted thoracoscopic surgery: A systematic review and meta-analysis of randomized controlled trials
Aysenur Dostbil1,2, Kamber Kasali2,3, Yener Aydin2,4, Ilker Ince2,5,6,7, Ali Bilal Ulas4, Mehmet Akif Yilmaz1, Muhammed Ceren1, Atilla Eroğlu4, Habip Burak Ozgodek8, Mirac Selcen Ozkal1, Hesham Elsharkawy9,10
1Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Türkiye
2Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Türkiye
3Department of Biostatistics, Atatürk University Faculty of Medicine, Erzurum, Türkiye
4Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
5Department of Anesthesiology and Perioperative Medicine, Penn State University Milton S. Hershey Medical Center, Pennsylvania, USA
6Department of Anesthesiology and Reanimation, Altınbaş University MedicalPark Hospital, İstanbul, Türkiye
7Outcomes Research Consortium, Houston, Texas, USA
8Department of Anesthesiology and Reanimation, Erzurum City Hospital, Erzurum, Türkiye
9Department of Anesthesiology, Pain, and Healing Center, MetroHealth Vice Chair for Anesthesiology Research, Ohio, USA
10Case Western Reserve University Outcomes Research Consortium, Ohio, USA
DOI : 10.5606/tgkdc.dergisi.2024.26887
Background: The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques.

Methods: In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed.

Results: Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; I2=97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p<0.001; I2=0%; fixed effects model) and lower than in LIA (SMD=?1.77; 95% CI, ?2.24 to ?1.30; Z=7.41; p<0.001; I2=0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=?2.90; 95% CI, ?5.29 to ?0.50; Z=2.37; p=0.02; I2=93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; I2=0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p<0.001; I2=0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting.

Conclusion: After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.

Keywords : Postoperatif opioid consumption, serratus anterior plane block, systematic review and meta-analysis, video-assisted thoracoscopic surgery
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