Abstract
The serratus plane block is a regional anesthesia technique awaiting efficacy and
safety evaluation in breast cancer surgery, but evidence is unclear. This meta-analysis
evaluates the analgesic effectiveness of serratus plane block vis-à-vis general anesthesia
and paravertebral block for breast cancer surgery. We searched for randomized controlled
trials in PubMed, the Cochrane Library, and Web of Science with no language limitation,
comparing the serratus plane block with multimodal analgesia or the thoracic paravertebral
block in breast cancer surgery. The Hartung-Knapp-Sidik-Jonkman method in combination
with a random-effects model was used to pool data. We included 12 randomized controlled
trials (799 patients). Compared with multimodal analgesia, pooled outcomes favored
the use of serratus plane block for effectively alleviating acute postoperative pain
severity at multiple time points. The serratus plane block also resulted in decreased
postoperative analgesic consumption of 28.81mg (95% confidence interval [CI]: −51.20,
−6.43), decreased intraoperative fentanyl consumption of −56.46 mg (95% CI: −79.61,
−33.30), increased duration of postoperative anesthesia of 243.85 min (95% CI: 104.38,
383.31), and reduced postoperative nausea and vomiting with a log relative risk of
−1.07 (95% CI: −1.90, −0.24). Compared with the thoracic paravertebral block, the
serratus plane block was not statically worse for all of the outcomes assessed. No
adverse effects were reported. The serratus plane block effectively alleviates acute
postoperative pain, reduces the rate of postoperative nausea and vomiting, and improves
perioperative anesthesia outcomes in breast cancer surgery, and it may represent an
alternative to thoracic paravertebral block.
Keywords
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References
- Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA: Cancer J Clin. 2021; 71: 209-249https://doi.org/10.3322/caac.21660
- Cancer statistics, 2020.CA: Cancer J Clin. 2020; 70: 7-30https://doi.org/10.3322/caac.21590
- An alternative technique for effective pain management in upper extremity surgery: Erector spinae plane block.Minerva Anestesiol. 2020; 86: 358-360https://doi.org/10.23736/s0375-9393.19.14080-1
- Pain after breast surgery: a survey of 282 women.Pain. 1996; 66: 195-205https://doi.org/10.1016/0304-3959(96)03064-3
- Acute and persistent postoperative pain after breast surgery.Pain Med. 2009; 10: 708-715https://doi.org/10.1111/j.1526-4637.2009.00611.x
- Essential elements of multimodal analgesia in Enhanced Recovery After Surgery (ERAS) guidelines.Anesthesiol Clin. 2017; 35: e115-e143https://doi.org/10.1016/j.anclin.2017.01.018
- Pectoralis-II myofascial block and analgesia in breast cancer surgery: a systematic review and meta-analysis.Anesthesiology. 2019; 131: 630-648https://doi.org/10.1097/aln.0000000000002822
- A comprehensive review of the diagnosis, treatment, and management of postmastectomy pain syndrome.Curr Pain Headache Rep. 2020; 24: 41https://doi.org/10.1007/s11916-020-00876-6
- Lest we forget: learning and remembering in clinical practice.Anaesthesia. 2013; 68: 1099-1103https://doi.org/10.1111/anae.12412
- Opioid-sparing effects of the thoracic interfascial plane blocks: a meta-analysis of randomized controlled trials.Saudi J Anaesth. 2018; 12: 103-111https://doi.org/10.4103/sja.SJA_382_17
- Bilateral thoracic paravertebral block: potential and practice.Br J Anaesth. 2011; 106: 164-171https://doi.org/10.1093/bja/aeq378
- Serratus plane block: a novel ultrasound-guided thoracic wall nerve block.Anaesthesia. 2013; 68: 1107-1113https://doi.org/10.1111/anae.12344
- Perioperative breast analgesia: a qualitative review of anatomy and regional techniques.Reg Anesth Pain Med. 2017; 42: 609-631https://doi.org/10.1097/aap.0000000000000641
- Pain control in breast surgery: survey of current practice and recommendations for optimizing management - American Society of Breast Surgeons Opioid/Pain Control Workgroup.Ann Surg Oncol. 2020; 27: 985-990https://doi.org/10.1245/s10434-020-08197-z
- The serratus plane block for postoperative analgesia in breast and thoracic surgery: a systematic review and meta-analysis.Reg Anesth Pain Med. 2019; 44: 1066-1074https://doi.org/10.1136/rapm-2019-100982
- Undue reliance on I(2) in assessing heterogeneity may mislead.BMC Med Res Methodol. 2008; 8: 79https://doi.org/10.1186/1471-2288-8-79
- The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.Int J Surg. 2021; 88105906https://doi.org/10.1016/j.ijsu.2021.105906
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13https://doi.org/10.1186/1471-2288-5-13
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898https://doi.org/10.1136/bmj.l4898
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394https://doi.org/10.1016/j.jclinepi.2010.04.026
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634https://doi.org/10.1136/bmj.315.7109.629
- Meta-analysis in clinical trials revisited.Contemp Clin Trials. 2015; 45 (Pt A): 139-145https://doi.org/10.1016/j.cct.2015.09.002
- The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method.BMC Med Res Methodol. 2014; 14: 25https://doi.org/10.1186/1471-2288-14-25
- Adjusting for multiple testing—when and how?.J Clin Epidemiol. 2001; 54: 343-349https://doi.org/10.1016/s0895-4356(00)00314-0
- Opioid equianalgesic calculations.J Palliat Med. 1999; 2: 209-218https://doi.org/10.1089/jpm.1999.2.209
- Grading quality of evidence and strength of recommendations.BMJ. 2004; 328: 1490https://doi.org/10.1136/bmj.328.7454.1490
- Breast cancer EDGE task force outcomes: clinical measures of pain.Rehabil Oncol. 2014; 32: 13-21https://doi.org/10.1097/01893697-201432010-00004
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558https://doi.org/10.1002/sim.1186
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: D5928https://doi.org/10.1136/bmj.d5928
- Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for postmastectomy analgesia.Benha Med J. 2018; 35: 429-436https://doi.org/10.4103/bmfj.bmfj_162_18
- Modified pectoral nerve block versus serratus block for analgesia following modified radical mastectomy: a randomized controlled trial.J Pain Res. 2020; 13: 1769-1775https://doi.org/10.2147/JPR.S252539
- A prospective randomised study to assess the analgesic efficacy of serratus anterior plane (SAP) block for modified radical mastectomy under general anaesthesia.Turk J Anaesthesiol Reanim. 2021; 49: 124-129https://doi.org/10.5152/tjar.2020.13
- Efficacy of serratus anterior muscle block as a part of multimodal analgesic regimen in patients undergoing modified radical mastectomy.Sri Lankan J Anaesthesiol. 2020; 28: 125-130https://doi.org/10.4038/slja.v28i2.8547
- Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: a randomised, controlled trial.Indian J Anaesth. 2017; 61: 381-386https://doi.org/10.4103/ija.IJA_62_17
- Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation.J Clin Anesth. 2016; 34: 91-97https://doi.org/10.1016/j.jclinane.2016.04.003
- Analgesic efficacy and spread of local anesthetic in ultrasound-guided paravertebral, pectoralis II, and serratus anterior plane block for breast surgeries: a randomized controlled trial.Saudi J Anaesth. 2020; 14: 464-472https://doi.org/10.4103/sja.SJA_822_19
- Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks.Korean J Anesthesiol. 2020; 73: 425-433https://doi.org/10.4097/kja.20159
- Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial.Reg Anesth Pain Med. 2019; 44: 52-58https://doi.org/10.1136/rapm-2018-000004
- Impact of the ultrasound-guided serratus anterior plane block on post-mastectomy pain: a randomised clinical study.Turk J Anaesthesiol Reanim. 2018; 46: 388-392https://doi.org/10.5152/TJAR.2018.86719
- Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy (in Chinese).Natl Med J China. 2019; 99: 1809-1813https://doi.org/10.3760/cma.j.issn.0376-2491.2019.23.012
- Ultrasound-guided serratus plane block enhances pain relief and quality of recovery after breast cancer surgery: a randomised controlled trial.Eur J Anaesthesiol. 2019; 36: 436-441https://doi.org/10.1097/eja.0000000000001004
- Effect of wound infiltration with ropivacaine or bupivacaine analgesia in breast cancer surgery: a meta-analysis of randomized controlled trials.Int J Surg (Lond Engl). 2015; 22: 79-85https://doi.org/10.1016/j.ijsu.2015.07.715
- Preemptive Analgesic Efficacy of the Ultrasound-Guided Bilateral Superficial Serratus Plane Block on Postoperative Pain in Breast Reduction Surgery: A Prospective Randomized Controlled Study.Aesthetic Plast Surg. 2020; 44: 37-44https://doi.org/10.1007/s00266-019-01542-y
- Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia.Sci Rep. 2018; 8: 7815https://doi.org/10.1038/s41598-018-26273-z
- Ultrasound-guided pectoral nerve block I and serratus-intercostal plane block alleviate postoperative pain in patients undergoing modified radical mastectomy.Pain Phys. 2019; 22: E315-E323
- Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery.Cochrane Database Syst Rev. 2012; 10CD007105https://doi.org/10.1002/14651858.CD007105.pub2
Article info
Publication history
Published online: October 18, 2022
Accepted:
October 13,
2022
Received in revised form:
October 10,
2022
Received:
March 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
