{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:11:46Z","timestamp":1784772706122,"version":"3.55.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effect of ultrasound-guided bilateral serratus anterior plane block (SAPB) in selected pediatric patients undergoing pectus bar removal, focusing on those with anticipated higher pain sensitivity or risk of opioid-related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on pediatric patients aged 6\u201317 years who underwent elective pectus bar removal under general anesthesia between September 2024 and February 2025. Patients were categorized into two groups: those receiving ultrasound-guided bilateral SAPB (Group S, <jats:italic>n<\/jats:italic>\u2009=\u200930) based on clinical factors such as pain sensitivity or risk of opioid-related complications, and a control group without SAPB (Group C, <jats:italic>n<\/jats:italic>\u2009=\u200946). Pain scores at rest and during coughing were assessed using the Numerical Rating Scale (NRS) immediately after awakening (Aldrete score\u2009\u2265\u20099) and at 1, 3, 6, 12, and 24\u2005hours postoperatively. General patient information, dosages of sufentanil, propofol, and remifentanil, postoperative fentanyl supplementation, surgical duration, anesthesia duration, extubation time, and adverse events such as postoperative nausea and vomiting were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Group S exhibited significantly lower incidences of postoperative hypoxemia and lower resting and coughing NRS scores within 6\u2005hours postoperatively compared to Group C (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.008, Bonferroni-corrected). SAPB significantly reduced perioperative opioid use (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). No statistically significant differences were observed in postoperative nausea and vomiting, delayed ambulation, or delayed oral intake (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In selected pediatric patients undergoing pectus bar removal, SAPB, as part of a multimodal analgesia regimen, was associated with improved perioperative analgesia, reduced postoperative hypoxemia, and decreased opioid use. While SAPB provides clear benefits in reducing postoperative pain and opioid use, we do not suggest routine implementation in all patients. Instead, its use should be individualized based on patient-specific factors such as pain sensitivity, previous analgesic response, and risk of opioid-related complications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1600442","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T05:32:53Z","timestamp":1754026373000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of ultrasound-guided serratus anterior plane block in pediatric patients undergoing pectus bar removal: a retrospective study of selected cases"],"prefix":"10.3389","volume":"13","author":[{"given":"Lianzhe","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenghua","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.jpedsurg.2012.10.036","article-title":"Increasing age at time of pectus Excavatum repair in children: emerging consensus?","volume":"48","author":"Papandria","year":"2013","journal-title":"J Pediatr Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1016\/j.jpedsurg.2005.05.010","article-title":"Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival","volume":"40","author":"Kelly","year":"2005","journal-title":"J Pediatr Surg"},{"key":"B3","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/978-3-319-43642-5_10","article-title":"Thoracoscopic treatment of pectus Excavatum: the nuss procedure","volume-title":"The Sages Manual of Pediatric Minimally Invasive Surgery","author":"Cromeens","year":"2017"},{"key":"B4","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1016\/j.jpedsurg.2020.11.001","article-title":"Pectus bar removal - why, when, where and how","volume":"56","author":"Haecker","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1111\/anae.12344","article-title":"Serratus plane block: a novel ultrasound-guided thoracic wall nerve block","volume":"68","author":"Blanco","year":"2013","journal-title":"Anaesthesia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1001\/jamasurg.2024.0969","article-title":"Serratus anterior plane blocks for early rib fracture pain management: the sabre randomized clinical trial","volume":"159","author":"Partyka","year":"2024","journal-title":"JAMA Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3344\/kjp.2021.34.2.234","article-title":"Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study","volume":"34","author":"Baytar","year":"2021","journal-title":"Korean J Pain"},{"key":"B8","doi-asserted-by":"publisher","first-page":"CD001548","DOI":"10.1002\/14651858.CD001548.pub2","article-title":"Single dose oral ibuprofen for acute postoperative pain in adults","volume":"2009","author":"Derry","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"CD013264","DOI":"10.1002\/14651858.CD013264.pub2","article-title":"Single-Dose intravenous ibuprofen for acute postoperative pain in adults","volume":"9","author":"Ferguson","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD009121","DOI":"10.1002\/14651858.CD009121.pub2","article-title":"Paravertebral block versus thoracic epidural for patients undergoing thoracotomy","volume":"2","author":"Yeung","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1093\/bja\/87.1.47","article-title":"Safety and efficacy of postoperative epidural analgesia","volume":"87","author":"Wheatley","year":"2001","journal-title":"Br J Anaesth"},{"key":"B12","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1017\/s0265021503001443","article-title":"Nerve-,stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial","volume":"20","author":"Naja","year":"2003","journal-title":"Eur J Anaesthesiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2231","DOI":"10.2147\/JPR.S209012","article-title":"Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study","volume":"12","author":"Wang","year":"2019","journal-title":"J Pain Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"6104","DOI":"10.21037\/apm-21-199","article-title":"Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial","volume":"10","author":"Shi","year":"2021","journal-title":"Ann Palliat Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"S307","DOI":"10.4103\/ija.ija_149_22","article-title":"Analgesic efficacy of superficial versus deep serratus plane block for modified radical mastectomy under general anaesthesia: a randomised comparative study","volume":"66","author":"Bhoi","year":"2022","journal-title":"Indian J Anaesth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1305326","DOI":"10.3389\/fsurg.2023.1305326","article-title":"Serratus anterior plane block for acute pain management after pectus excavatum repair","volume":"10","author":"Rim","year":"2023","journal-title":"Front Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2411","DOI":"10.2147\/JPR.S207116","article-title":"Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial","volume":"12","author":"Chen","year":"2019","journal-title":"J Pain Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1093\/pm\/pnab214","article-title":"The effect of erector spinae block versus serratus plane block on pain scores and diaphragmatic excursion in multiple rib fractures. A prospective randomized trial","volume":"23","author":"El Malla","year":"2022","journal-title":"Pain Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1097\/AAP.0000000000000848","article-title":"Serratus plane block: a cadaveric study to evaluate optimal injectate spread","volume":"43","author":"Biswas","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1097\/AJP.0000000000001249","article-title":"Relative perioperative analgesic efficacy of superficial versus deep approach of serratus anterior plane block for anterior chest wall surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"40","author":"Singh","year":"2024","journal-title":"Clin J Pain"},{"key":"B21","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1002\/ejp.1533","article-title":"Ultrasound-guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic-assisted thoracic surgery","volume":"24","author":"Hanley","year":"2020","journal-title":"Eur J Pain"},{"key":"B22","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1097\/AAP.0000000000000649","article-title":"Injection volume and anesthetic effect in serratus plane block","volume":"42","author":"Kunigo","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1055\/s-0040-1705152","article-title":"Serratus anterior plane block and intercostal nerve block after thoracoscopic surgery","volume":"69","author":"Kim","year":"2021","journal-title":"Thorac Cardiovasc Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1600442\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T05:32:54Z","timestamp":1754026374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1600442\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":23,"alternative-id":["10.3389\/fped.2025.1600442"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1600442","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]},"article-number":"1600442"}}