Ultrasound-guided Serratus Anterior Plane Block, Along with Improved Parasternal Block, is Superior to Serratus Anterior Plane Block Alone in Relieving Pain for Rhinoplasty with Autologous Costal Cartilage

Chen C, Xiang G, Liu Q, Chen K, Wang H, Jin J, Huang Y, Deng X, Yang D, Yan F.

PubMed 36544049 Publisher (DOI)Free full text (PMC)

What this paper says

In 60 patients randomized between two nerve block regimens after rib cartilage rhinoplasty, adding a parasternal block lowered chest and nose pain scores through the first 12 hours and reduced rescue painkiller use.

Overview

Taking rib cartilage for rhinoplasty causes severe chest pain afterward. A serratus anterior plane block combined with a parasternal block has been reported effective for pain after chest wall surgery, but whether it helps after rib harvest was unclear. Sixty four patients aged 18 to 60 were randomly assigned to the combined block or the serratus block alone.

Sections of note

Randomized study; 30 patients per group were analysed; level of evidence II.
Measures were chest pain at rest and on coughing, and nose pain, on a numerical rating scale at 2, 4, 8, 12, 24 and 48 hours.
Rescue painkiller use, side effect rates and patient satisfaction were also recorded.
Chest pain at rest and on coughing, and nose pain, were all lower in the combined block group at 2, 4, 8 and 12 hours, all P less than 0.05.
Scores were comparable between groups at 24 and 48 hours.
Rescue painkiller use was substantially lower in the combined block group, P less than 0.05.
Nausea and vomiting were less frequent in that group, P less than 0.05.
Patient satisfaction was markedly higher in that group, P less than 0.001.

What it means for a patient

The chest, not the nose, is the main source of pain when rib cartilage is used.
Adding the second block improved pain control for the first 12 hours, after which the groups were equal.
Less need for rescue painkillers translated into less nausea and vomiting.
Sixty patients at one centre is a modest trial, though the randomized design strengthens the comparison.

Why this paper matters

Chest donor site pain is the main patient objection to rib cartilage rhinoplasty and can influence whether that graft source is chosen. This randomized trial tests a specific anesthetic solution. The benefit is confined to the first half day after surgery.

Terms

Serratus anterior plane block: an injection of local anesthetic into a chest wall muscle plane.
Parasternal block: an injection of local anesthetic beside the breastbone.
Ultrasound guided: performed with ultrasound imaging to place the needle accurately.
Autologous costal cartilage: rib cartilage taken from the patient's own body.
Numerical rating scale: a pain score reported by the patient on a number scale.
Rescue analgesic: additional painkiller taken when the planned regimen is insufficient.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest.

Methods: Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. RESULTS: Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower (P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished (P < 0.05), and the patient satisfaction was markedly higher (P < 0.001) in the SAPB+PSB group.

Conclusion: USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty.

Level Of Evidence Ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).