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Iranian Journal of Breast Diseases
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Serratus Plane Block as Promising Pain Management in Breast Cancer Surgery: An Updated Meta-Analysis
Dewangga Yudisthira *1 
, Muhammad Rico Abdul Karim2 , Athaya Rahmanardi Muhammad2 , Muhammad Reva Aditya2 , Azril Okta Ardiansyah3 , Andreas Andrianto4
, Muhammad Rico Abdul Karim2 , Athaya Rahmanardi Muhammad2 , Muhammad Reva Aditya2 , Azril Okta Ardiansyah3 , Andreas Andrianto4
1- , dewanggay369@gmail.com
2- Medical Faculty, Brawijaya University, Malang, Indonesia
3- Oncology Surgery Department, Universitas Airlangga Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
4- Oncology Surgery Department, Paru Hospital, Jember University, Jember, Indonesia
2- Medical Faculty, Brawijaya University, Malang, Indonesia
3- Oncology Surgery Department, Universitas Airlangga Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
4- Oncology Surgery Department, Paru Hospital, Jember University, Jember, Indonesia
Abstract: (25 Views)
Background: Postoperative pain remains common after surgery, and opioid-related adverse effects motivate multimodal alternatives. The serratus plane block (SPB) is used for breast surgery, but its comparative benefit remains uncertain.
Methods: We searched PubMed, the Cochrane Library, and ProQuest for English-language randomized trials and cohort studies published between January 2019 and December 2024 comparing an SPB-related intervention with a control or another technique in breast cancer surgery. We used RoB 2 and ROBINS-I to assess risk of bias. Random-effects analyses assessed pain at postoperative time points; secondary outcomes included rescue analgesia, postoperative nausea and vomiting (PONV), and operative duration.
Results: Eight studies (834 participants) were included. Bias concerns were generally low to moderate, with concerns about blinding and cohort confounding. SPB usually favored lower time-specific pain, but heterogeneity was often very high, and some comparisons were not significant. Rescue analgesia was less likely (OR 0.25, 95% CI 0.08–0.72; P=0.01; I²=66%) and PONV risk was lower (RR 0.31, 95% CI 0.12–0.80; P=0.02; I²=53%). Operative duration did not differ significantly (MD −3.69 min, 95% CI −7.52 to 0.14; P=0.06; I²=7%).
Conclusion: SPB may be considered as part of individualized multimodal analgesia, but heterogeneous protocols and limited evidence do not support universal superiority or routine use as standard of care.
Methods: We searched PubMed, the Cochrane Library, and ProQuest for English-language randomized trials and cohort studies published between January 2019 and December 2024 comparing an SPB-related intervention with a control or another technique in breast cancer surgery. We used RoB 2 and ROBINS-I to assess risk of bias. Random-effects analyses assessed pain at postoperative time points; secondary outcomes included rescue analgesia, postoperative nausea and vomiting (PONV), and operative duration.
Results: Eight studies (834 participants) were included. Bias concerns were generally low to moderate, with concerns about blinding and cohort confounding. SPB usually favored lower time-specific pain, but heterogeneity was often very high, and some comparisons were not significant. Rescue analgesia was less likely (OR 0.25, 95% CI 0.08–0.72; P=0.01; I²=66%) and PONV risk was lower (RR 0.31, 95% CI 0.12–0.80; P=0.02; I²=53%). Operative duration did not differ significantly (MD −3.69 min, 95% CI −7.52 to 0.14; P=0.06; I²=7%).
Conclusion: SPB may be considered as part of individualized multimodal analgesia, but heterogeneous protocols and limited evidence do not support universal superiority or routine use as standard of care.
Keywords: Serratus Plane Block, Post-Surgical Pain, Breast Cancer Surgery, Rescue Analgesia, Postoperative Nausea and Vomiting
Type of Study: review |
Subject:
Diagnosis, treatment, rehabilitation
Received: 2026/07/25 | Accepted: 2026/09/30
Received: 2026/07/25 | Accepted: 2026/09/30
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