Ultrasound-Guided Serratus Anterior Plane Block in Pediatric Microtia Reconstruction: A Systematic Review and Single-Arm Meta-Analysis.

BACKGROUND

Costal cartilage harvest for autologous auricular reconstruction in children with microtia is associated with significant postoperative chest wall pain. Ultrasound-guided serratus anterior plane block (SAPB) has emerged as a promising analgesic technique for this population, yet pooled quantitative estimates of its efficacy and safety are lacking.

OBJECTIVES

To perform a systematic review and single-arm meta-analysis estimating the pooled efficacy and safety of ultrasound-guided SAPB in pediatric patients undergoing auricular reconstruction with costal cartilage harvest.

METHODS

We systematically searched PubMed, Scopus, and the Cochrane Library from inception to February 26, 2026, following PRISMA guidelines and the Cochrane Handbook. The study protocol was registered in PROSPERO (CRD420261293444). Eligible studies enrolled pediatric patients with microtia undergoing auricular reconstruction with costal cartilage harvest and reported at least 1 prespecified outcome. Pooled means and proportions were calculated using the inverse variance method with random-effects models. Between-study heterogeneity was assessed using the Cochran Q test and I2 statistic.

RESULTS

Five randomized controlled trials enrolling 179 patients were included. Pooled rest pain scores peaked at 12 hours (mean: 3.28, 95% CI: 3.09-3.49; I2=51%) and declined to 1.15 (95% CI: 0.81-1.63) at 48 hours. Cough pain similarly peaked at 12 hours (mean: 4.35, 95% CI: 3.92-4.82; I2=90%) and resolved to mild levels by 48 hours. The pooled mean analgesic duration was 11.65 hours (95% CI: 10.59-12.80; I2=87%), 24-hour PCIA consumption was 55.65 mL (95% CI: 46.13-67.15; I2=99%), and rescue analgesic incidence was 18.37% (95% CI: 11.88%-27.30%; I2=0%). Pooled adverse event rates were low: dizziness 6.10% (95% CI: 3.00%-11.98%), postoperative nausea and vomiting 14.97% (95% CI: 9.96%-21.90%), and pruritus 1.77% (95% CI: 0.51%-5.92%). Pooled mean extubation time was 14.31 minutes (95% CI: 13.66-14.99), and ambulation time was 18.68 hours (95% CI: 17.61-19.83). Sensitivity analyses confirmed the stability of all pooled estimates.

CONCLUSIONS

Ultrasound-guided SAPB provides consistent early donor-site analgesia in pediatric microtia reconstruction, reducing supplemental opioid requirements and supporting favorable recovery profiles without increasing procedural complications. These findings support its integration into multimodal perioperative analgesia strategies for this population.

LEVEL OF EVIDENCE: Level IV-therapeutic study.