Efficacy and Safety of Serratus Anterior Plane Block and Erector Spinae Plane Block for Rib Fracture Pain: A Systematic Review and Meta-analysis.

OBJECTIVES

Fascial plane blocks (FPBs), including serratus anterior plane block (SAPB) and erector spinae plane block (ESPB), are regional anesthesia techniques targeting the plane between fascial layers. We aimed to evaluate the analgesic efficacy and safety of FPBs in patients with rib fractures.

METHODS

PubMed, EMBASE, Cochrane Library, and Google Scholar were searched through August 2025. We included prospective studies comparing the pain-relieving efficacy of FPBs with that of standard care (no block) or thoracic epidural analgesia. SAPB and ESPB were analyzed collectively to assess overall analgesic efficacy, with subgroup analyses performed to examine their individual effects. Bayesian analysis was performed for validation.

RESULTS

This review included 9 studies (600 patients). The results indicated that FPBs outperformed standard care in relieving pain for up to 6 hours postblock (standardized mean difference [SMD]: -0.58; 95% CI: -0.99 to -0.17). The analgesic efficacy of FPBs was similar to that of thoracic epidural analgesia for up to 48 hours (SMD: -0.13; 95% CI:-0.45 to 0.2). FPBs reduced in-hospital opioid use (SMD: -0.81; 95% CI: -1.72 to 0.11) and stabilized hemodynamic parameters. In subgroup analyses, both SAPB and ESPB demonstrated consistent trends in analgesic efficacy. These findings were corroborated in Bayesian analyses. Regarding safety, FPBs were associated with lower risks of hypotension (risk difference: -0.24; 95% CI: -0.36 to -0.12) and nausea and vomiting (risk difference: -0.19; 95% CI: -0.39 to 0.01).

DISCUSSION: SAPB and ESPB can be promising options for rib fracture analgesia, particularly in emergency settings. Further studies are warranted to validate our findings.