• Burhan Dost, Dario Bugada, Yunus Emre Karapinar, Eleonora Balzani, Muzeyyen Beldagli, Giulia Aviani Fulvio, Mirac Selcen Ozkal Yalin, Esra Turunc, Nicolò Sella, and Alessandro De Cassai.
• From the Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye (BD, ET), Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy (DB), Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Türkiye (YEK, MSOY), Department of Surgical Science, University of Turin, Torino, Italy (EB), Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun, Türkiye (MB), Department of Medicine (DIMED), University of Padua, Padua, Italy (GAF, ADC), and Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy (NS, ADC).
• Eur J Anaesthesiol. 2025 Feb 12.

BackgroundBreast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.ObjectiveIn this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.DesignA meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).Data SearchWe systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).Eligibility CriteriaRCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.ResultsEighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.ConclusionPVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.Copyright © 2025 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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