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Objective: Our meta‐analysis aimed to compare the analgesic effectiveness of ultrasound‐guided preoperative erector spinae plane block (ESPB) versus paravertebral nerve block (PVB) in breast surgery. Methods: PubMed, EMBASE, and the Cochrane Library were searched for randomized controlled trials (RCTs) between January 1, 1980 and April 31, 2021. The primary endpoints were perioperative pain score, analgesic consumption, and assessment of the block procedure. The secondary endpoints were intraoperative hemodynamic response, duration of surgery, postoperative antiemetic consumption, and adverse effects. Results: Four RCTs comprised a total of 310 patients were included in our meta‐analysis. No significant differences in the perioperative pain score and analgesic consumption were observed between ESPB and PVB in the operating room, post‐anesthesia care unit (PACU), and ward (at 1, 16, 12, and 24 h), and the morning of postoperative day 1 (POD1) (all p > 0.05). Similarly, no significant differences in the duration of block, time to first analgesic, hemodynamic response, duration of surgery, postoperative antiemetic consumption, and adverse effects were observed (all p > 0.05). However, our meta‐analysis revealed that ultrasound‐guided preoperative ESPB significantly reduced the duration of procedure time and frequency of guidance interventions, as well as increased the block success rate among residents (all p < 0.05). Conclusions: Both ultrasound‐guided preoperative ESPB and PVB showed comparable analgesic effects in patients undergoing breast surgery. However, with a significantly shorter procedure time and higher block success rate, our findings suggest that ESPB may be a simple alternative to PVB in breast surgery. [ABSTRACT FROM AUTHOR]

Objective To investigate whether perioperative ultrasound-guided serratus anterior plane block (SAPB) combined with general anesthesia is more effective and safer than current analgesic techniques for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). Methods PubMed, the Cochrane Library, and EMBASE were searched for clinical trials published up to July 31, 2019. Outcomes, including operative duration, postoperative pain scores, postoperative analgesia use, patient satisfaction with analgesia, time to chest tube removal, length of stay, and adverse effects were analyzed. Results Four clinical trials, including 262 patients, met inclusion criteria. Ultrasound-guided SAPB reduced pain scores at zero, 15, 30, 45, and 60 minutes in the postoperative anesthesia care unit (all P  < 0.05) and at one, two, six, 12, and 24 hours in the ward (all P  < 0.001). Additionally, postoperatively, morphine consumption at 15 and 30 minutes, overall morphine consumption, and total consumption (morphine plus tramadol) were significantly lower in the SAPB cohort (P  < 0.05). Similarly, postoperative tramadol consumption at one, two, six, 12, and 24 hours was also lower in this cohort (all P  < 0.05). The postoperative consumption of fentanyl, tramadol, and total morphine in patient-controlled analgesia (PCA) at 24 hours was significantly reduced (P  < 0.05). Moreover, SAPB provided better patient satisfaction with analgesia (P  = 0.0038). However, no statistically significant difference was found in duration of operation, time to chest tube removal, length of stay, or side effects (all P  > 0.05). Conclusions Perioperative ultrasound-guided SAPB combined with general anesthesia provided more effective postoperative analgesia after VATS. However, no significant advantage was found regarding side effects. [ABSTRACT FROM AUTHOR]