Efficacy of serratus anterior plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial

Abstract

Background Postoperative nausea and vomiting (PONV) still often occurs after surgery, which adversely affects recovery and patient satisfaction. Serratus anterior plane block (SAPB) has been proposed as a regional anesthesia technique that may reduce PONV indirectly by improving postoperative analgesia and decreasing perioperative opioid requirements. Methods A systematic review and meta-analysis of the randomized controlled trial (RCT) was conducted to evaluate the impact of SAPB on PONV. From its establishment to April 20, 2026, the central register of PubMed, Embase, CNKI and Cochrane controlled trials was searched. Eligible studies include adults who underwent surgery under general anesthesia with a control group (placebo or no intervention). The main results are the incidence of postoperative nausea and vomiting; the secondary results include postoperative opioid consumption, pain score (visual analog scale, VAS), hospitalization time, the time of first rescue analgesia, and the incidence of headache or hypotension. Random effect element analysis was carried out to gather risk differences (RD) and standardized mean differences (SMD) with 95% confidence intervals (CI). Use GRADE to evaluate the certainty of evidence and apply test sequence analysis (TSA) to evaluate robustness. Results Twenty RCTs involving 1,651 patients were included. Compared with control treatment, SAPB was associated with a reduced incidence of postoperative nausea (RD = −0.17; 95% CI: −0.23 to −0.11; I2 = 67%; moderate-certainty evidence). SAPB may also reduce postoperative vomiting, although this finding was borderline and should be interpreted cautiously (RD = −0.13; 95% CI: −0.25 to −0.00; I2 = 79%; moderate-certainty evidence). SAPB reduced fentanyl consumption (SMD = −1.08; 95% CI: −1.86 to −0.31) and remifentanil consumption (SMD = −2.14; 95% CI: −3.25 to −1.03), whereas sufentanil consumption was not significantly reduced. SAPB also improved postoperative pain scores, shortened hospital stay, prolonged the time to first rescue analgesia, and reduced headache incidence. Funnel plot inspection and Egger’s and Begg’s tests did not suggest significant small-study effects for postoperative nausea. Risk-of-bias concerns were mainly related to insufficient reporting of allocation concealment and blinding procedures. Conclusion SAPB appears to reduce postoperative opioid requirements and improve analgesia in patients undergoing breast and thoracic surgery. These benefits are associated with a reduced incidence of postoperative nausea and may contribute to enhanced recovery. However, the current evidence does not establish an independent direct antiemetic effect of SAPB, and the effect on postoperative vomiting should be interpreted cautiously. Further high-quality RCTs with standardized opioid and antiemetic protocols are needed to clarify the causal pathway between SAPB, opioid reduction, and PONV. Systematic review registration https://www.crd.york.ac.uk/prospero/CRD420261373467, identifier CRD420261373467.