Efficacy and safety of ultrasound-guided bilateral superficial serratus anterior plane block for postoperative analgesia in pediatric ear reconstruction with costal cartilage harvest: a randomized controlled trial.

BACKGROUND

Patients with microtia undergoing ear reconstruction with costal cartilage harvest often experience significant postoperative chest pain. The efficacy and safety of ultrasound-guided superficial serratus anterior plane block (SSAPB) in pediatric patients remain unclear.

METHODS

In this randomized controlled trial, sixty children were randomized to SSAPB or incision infiltration anesthesia (IA) (30 ml of 0.25% ropivacaine each).

PRIMARY OUTCOME: group × time interaction on pain NRS trajectories (rest/coughing) over 48 h. Secondary outcomes were patient-controlled intravenous analgesia (PCIA) activations, oral rescue analgesic use, mobilization time, and adverse effects.

RESULTS

The interaction effect was non-significant for rest (p = 0.28) and coughing (p = 0.15). The SSAPB group exhibited significantly lower NRS scores at rest compared to IA, with mean differences (95% CI) of - 0.56 (- 1.02 to - 0.11) at 1 h, - 0.93 (- 1.56 to - 0.30) at 6 h, - 1.10 (- 1.96 to - 0.24) at 12 h, and - 1.17 (- 1.84 to - 0.49) at 24 h (p < 0.05 for all). During coughing, mean differences (95% CI) were - 1.03 (- 1.52 to - 0.54) at 1 h, - 0.94 (- 1.42 to - 0.46) at 6 h, - 0.84 (- 1.42 to - 0.26) at 12 h, and - 1.67 (- 2.25 to - 1.09) at 24 h (p < 0.05 for all). SSAPB reduced PCIA activations (6 ± 3.5 vs. 12 ± 4.6; p < 0.001), rescue analgesics (20% vs. 53%; p < 0.01), and accelerated mobilization (20.45 ± 1.76 vs. 23.30 ± 1.94 h; p < 0.001). Adverse events were comparable.

CONCLUSIONS

SSAPB significantly reduces postoperative pain for up to 24 h and decreases analgesic use in children undergoing ear reconstruction with costal cartilage harvest, enhancing pain management and patient satisfaction without increasing adverse effects.

CLINICAL TRIAL REGISTRATION: ChiCTR2200060242.