The purpose of this article is to systematically evaluate the postoperative analgesia and side effects of ultrasound-guided low serratus anterior plane block combined with rectus sheath block in upper abdominal surgery. We searched PubMed, Embase, CNKI, Wanfang Database, and Chinese Biomedical Literature Database (CBM) to find randomized controlled trials on the use of ultrasound-guided low serratus anterior plane block combined with rectus sheath block in upper abdominal surgery. The search period was defined as the database establishment until April 2024. Patients included in the analysis were divided into two groups according to according to different anesthesia methods: ultrasound-guided low serratus anterior plane block combined with rectus sheath block and general anesthesia group (experimental group), simple general anesthesia group (control group). Meta-analysis was performed using RevMan 5.3 software. Finally, 4 literatures with a total of 271 patients could be included in this systematic review. The results of meta-analysis showed that compared with the control group, the experimental group can reduce at the resting state pain scores at 2 hours after surgery (MD=-1.56, 95% CI -1.72~ -1.41, P<0.00001) , the resting state pain scores at 6 hours after surgery (MD=-1.87, 95% CI -2.03~ -1.71, P<0.00001) , the resting state pain scores at 12 hours after surgery (MD=-1.50, 95% CI -1.69~ -1.31, P<0.00001), the resting state pain scores at 24 hours after surgery (MD=-0.72, 95% CI -0.88~ -0.56, P<0.00001), the resting state pain scores at 48 hours after surgery (MD=-0.01, 95% CI -0.17~ 0.15, P=0.92), the number of postoperative analgesic pump compressions (MD=-4.22, 95% CI -4.99~ -3.45, P<0.00001) , and the incidence of nausea and vomiting (RR=0.33, 95% CI 0.17~0.64, P=0.0010). There was no significant difference in the incidence of dizziness (RR=0.58, 95% CI 0.25~ 1.35, P=0.21), and the incidence of respiratory depression (RR=0.42, 95% CI 0.10~ 1.66, P=0.21) between the two groups. The upper abdominal surgery with ultrasound-guided low anterior serrated muscle plane combined with rectus sheath block technique has obvious analgesic effect and does not cause obvious adverse reactions, which is worthy of clinical promotion.

Yang Li, Liang Yu, Dai Xuemei. Meta-analysis of ultrasound-guided low serratus anterior plane block combined with rectus sheath block for postoperative analgesia and side effects of upper abdominal surgery. International Journal of Frontiers in Medicine (2024), Vol. 6, Issue 5: 97-103. https://doi.org/10.25236/IJFM.2024.060513.

[1] Li Qianqian,Liu Zhiyi,Yu Qi,et al. Application of ultrasound-guided transversus abdominis plane block combined with rectus abdominis sheath block in peritoneal dialysis placement[J]. Practical Clinical Medicine,2018,v.19(07):44-46+50.

[2] Gong Taowu,Zhao Nan,Qin Hanrui,et al. Ultrasound-guided transversus abdominis plane block combined with posterior rectus abdominis sheath block in postoperative analgesia of gynecologic open heart surgery[J]. Imaging Research and Medical Application,2018,v.2(19):146-148.

[3] Xie C Y, Ran G, Chen D Q, et al. A narrative review of ultrasound-guided serratus anterior plane block [J]. Ann Palliat Med, 2021, 10(1): 700-706.

[4] Lu Yelan, Lin Jiayan. Clinical application of ultrasound-guided anterior serrate muscle plane combined with rectus sheath block combined with controlled intravenous analgesia in laparoscopic surgery for liver tumors [J]. Oncology Basis and Clinic, 2019,33(04):304-307.

[5] Xu Shuai. Analgesic effect of ultrasound-guided lower serus anterior plane combined with rectus sheath block in upper abdominal surgery [J]. Journal of Clinical Medical Literature Electronic, 2019, 7(13):34-35.

[6] WANG Haoran, Guo Miao, Gong Chanjuan. Application of ultrasound-guided anterior serration combined with bilateral rectus sheath block in perioperative analgesia of partial hepatectomy [J]. Journal of Nanjing Medical University (Natural Science Edition), 2021,41(10):1513-1516.

[7] DING Yao-mao, Li Sheng, ZHANG Pei-Bing, et al. Analgesic effect of ultrasound-guided low anterior serrat plane combined with rectus sheath block in laparotomy hepatobiliary surgery [J]. Imaging Research and Medical Applications, 2019,7(16):188-190.

[8] Zhou Qiaoling, Xu Feng, Li Lujun, et al. Different doses of dexmedetomidine combined with ropivacaine transversus abdominis plane block for analgesia in laparoscopic colon cancer surgery [J]. Journal of practical medicine, 2016, 32( 24) : 4108 - 4110.

[9] Thornblade L W,Seo Y D,Kwan T,et al. Enhanced recovery via peripheral nerve block for open hepatatectomy[J]. J Gastrointest Surg,2018,22(6):981-988.

[10] Qin Tao, Dan Songshan, Li Yang, et al. Multimodal analgesia after open thoracic malignant tumor resection [J]. Journal of practical medicine, 2017, 33( 8) : 1266 - 1269.

[11] SVIGGUM HP,NIESEN AD,SITES BD,et al. Trunk blocks 101: transversus abdominis plane, ilioinguinal-iliohypogastric,and rectus sheath blocks[J]. Int Anesthesiol Clin,2012,50 ( 1 ) : 74-92.

[12] Lin JH, Liu XF, Wang Q, et al . Effect of ultrasound-guided morphine combined with ropivacaine anterior serratus muscle plane block of different concentrations on postoperative analgesia in breast cancer patients [J] . Shandong Medicine, 2020, 60(23):70-72.

[13] Zeng Xiaoping, Shi Hong, Wu Wei, et al. Research progress of ultrasound-guided anterior serratus plane block [J]. Journal of Clinical Anesthesiology, 2021, 37(9):991-993.

[14] Chai Bin, Lin Wenxin, Zheng Huili, et al. Ultrasound-guided anterior serratus plane compound rectus abdominis sheath block in open surgery for hepatocellular carcinoma [J]. Journal of practical medicine,2018(2):339-340.

[15] Dutton Tj,Mcgrath Js,Daugherty Mo. Use of rectus sheath catheters for pain relief in patients undergoing major pelvic urological surgery[J]. BJU Int,2014,113( 2) : 246 -253.

[16] R ELLAND LM,TOBIAS JD ,MARTIN D,et al. Ultrasoundguided rectus sheathblock, caudalanalgesia, or surgical site infiltration for pediatric umbilical herniorrhaphy: a prospective, doubleblinded, randomized comparison of three regional anesthetic techniques[J]. J Pain Res ,2017,10: 2629-2634.