The efficacy and safety of serratus anterior plane block in patients undergoing cardiac surgery: A systematic review and meta-analysis.

BACKGROUND

Serratus anterior plane block (SAPB) is a widely used fascial block that reduces postoperative pain and perioperative opioid consumption. This meta-analysis assessed the efficacy and safety of SAPB in cardiac surgery patients.

METHODS

We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang databases on May 10, 2024. Pooled relative risks and mean differences (MD) with 95% confidence intervals (CI) were calculated for dichotomous and continuous outcomes, respectively. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using Egger test. Subgroup analyses were stratified by study design (randomized controlled trials vs cohort studies) and patient age to explore methodological heterogeneity.

RESULTS

Fifteen studies, encompassing 1169 adult and pediatric participants, were included. Overall, compared to general anesthesia (GA) alone, the SAPB + GA group significantly reduced intensive care unit length of stay (MD = -6.61 hours, 95% CI: -10.91 to -2.32), decreased postoperative analgesic consumption (MD = -4.20 mg morphine equivalents, 95% CI: -6.52 to -1.88), and lowered the risk of complications (relative risk = 0.63, 95% CI: 0.40-0.99). SAPB + GA also lowered postoperative Visual Analogue Scale pain scores (MD = -1.25, 95% CI: -1.74 to -0.75) and serum cortisol levels (MD = -35.43 nmol/L, 95% CI: -58.58 to -12.27). No local anesthetic toxicity or mortality was reported.

CONCLUSIONS

Perioperative SAPB combined with GA provides significant benefits in cardiac surgery, including accelerated intensive care unit discharge, reduced opioid use and pain scores, attenuated stress response (reduced cortisol), and favorable safety, which supports enhanced patient recovery.