Bupivacaine 375mg/250ml (0.15%) / Fentanyl 500micrograms/250ml infusion bags

BackgroundSerratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) are widely used regional anesthesia techniques for postoperative analgesia and are generally considered safe and effective. However, the comparative efficacy remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB in adult patients undergoing thoracic and breast surgeries.MethodsA comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google Scholar up to February 28, 2025. Primary outcomes included time to first analgesic request (TFAR), 24-h total analgesic consumption (TAC) postoperatively, and 24-h postoperative pain scores at rest. Secondary outcomes comprised pain scores at various postoperative timepoints, intraoperative fentanyl consumption, length of hospital stay, patient satisfaction with analgesia, and incidence of complications. A random-effect model was applied for the meta-analysis.ResultsTwenty-eight 28 RCTs comprising 1796 patients were included. No significant differences were found between SAPB and TPVB in TFAR (mean difference [MD] = -0.68 h, 95% confidence interval [CI]: -1.55 to 0.18, P = 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, P = 0.334), other postoperative pain scores, length of hospital stay, patient satisfaction, or incidence of postoperative nausea and vomiting (risk ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, P = 0.310). Despite statistically significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73 mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, P = 0.005) did not exceed the minimal clinically important difference (MCID) of 10 mg. SAPB also resulted in greater intraoperative fentanyl consumption (MD = 13.85 mcg, 95%CI: 3.86 to 23.84, P = 0.007) but a significantly lower incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, P = 0.006). Subgroup analyses showed that TPVB provided superior, but non-clinically significant, opioid-sparing benefits in thoracic procedures (3.38 mg) and when compared to superficial SAPB (3.11 mg).ConclusionSAPB offers comparable analgesic efficacy to TPVB, with a more favorable safety profile but slightly higher opioid consumption. However, the increased opioid use does not exceed the MCID. Therefore, SAPB is a clinically effective and safe alternative to TPVB for perioperative regional analgesia in thoracic and breast surgeries.

Abstract licence: CC BY-NC-ND

BACKGROUND: The Erector Spinae Plane Block (ESPB) is a well-known regional anesthesia technique in adults. However, its effectiveness and analgesic efficiency have yet to be fully established in children. This meta-analysis aimed to determine the analgesic efficacy of ESPB in pediatric surgery. METHODS: Following PRISMA guidelines, we conducted a meta-analysis of prospective randomized clinical trials that compared the effects of ESPB versus the control group or different peripheral nerve blocks in pediatric surgery. RESULTS: Ten randomized controlled trials, involving 651 pediatric patients, were included in the synthesis following critical appraisal. Compared to no-block analgesia, ESPB significantly prolonged the time to the first rescue analgesia (SMD 1.30, 95% CI 0.38 to 2.22; p = 0.005) and reduced postoperative opioid consumption at 24 h (SMD -1.08, 95% CI -2.03 to -0.13; p = 0.03). ESPB also significantly lowered pain scores at 4 h (p = 0.008) and 6 h (p = 0.0003) postoperatively compared to no-block analgesia. However, ESPB did not significantly reduce intraoperative fentanyl consumption (SMD -0.21, 95% CI -1.14 to 0.71; p = 0.65). CONCLUSION: ESPB improved analgesic efficacy in pediatric surgery, particularly compared with caudal or no-block analgesia; however, the overall certainty of evidence ranged from low to moderate according to the GRADE approach. Further high-quality, methodologically robust RCTs are required. TRIAL REGISTRATION: The study was registered in the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42023483105).

Abstract licence: CC BY-NC-ND

Background/Objectives: Subarachnoid anaesthesia is widely preferred for caesarean delivery due to its rapid onset, reliability, and safety. The addition of adjuvants to intrathecal hyperbaric bupivacaine has been shown to enhance the quality of anaesthesia and prolong postoperative analgesia. Opioids are among the most frequently used intrathecal adjuvants; however, their administration is associated with adverse effects. Nalbuphine, a mixed opioid agonist-antagonist, may be a promising agent for obstetric use due to its favourable pharmacodynamic properties. This study aimed to systematically review and, where feasible, meta-analyse the evidence comparing nalbuphine with other intrathecal opioid adjuvants to hyperbaric bupivacaine 0.5% for caesarean section, with a primary focus on efficacy and safety. Methods: A systematic review and meta-analysis of controlled trials was conducted. Web of Science Core Collection, MEDLINE (PubMed), Scopus, the Library of Congress, and LISTA (EBSCO) were systematically searched to identify eligible studies. Pooled mean difference (MD) and risk ratio (RR) were calculated using random-effects model. Results: Ten studies encompassing 1095 parturients were included. Compared with fentanyl, intrathecal nalbuphine was associated with a modest prolongation of effective analgesia. However, this finding was accompanied by substantial heterogeneity and very low certainty of evidence. In contrast, morphine provided a longer duration of analgesia than nalbuphine. Overall, nalbuphine and fentanyl demonstrated comparable block characteristics, with only minimal and clinically insignificant differences in onset and duration. Importantly, nalbuphine was associated with fewer adverse effects, particularly shivering and PONV. Conclusions: Subarachnoid nalbuphine may serve as a potential alternative adjuvant to 0.5% hyperbaric bupivacaine in caesarean section anaesthesia. It may provide an analgesic efficacy comparable to fentanyl and, although less potent than morphine, it may demonstrate a more favourable safety profile.

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