Efficacy of rhomboid intercostal block for postoperative analgesia in patients undergoing breast surgery: A systematic review and meta-analysis.

Abstract

<h4>Background and aims</h4>The rhomboid intercostal plane block (RIB) is a regional anaesthesia technique that has shown promising results in breast and thoracic surgeries. This systematic review and meta-analysis evaluated the efficacy and safety of RIB in breast surgery.<h4>Methods</h4>The study was conducted as per PRISMA guidelines and registered in PROSPERO (CRD420251089477). Randomised controlled studies in which RIB was compared with other regional blocks or a control group for postoperative analgesia in breast surgeries were included in this study. Databases searched included PubMed, EMBASE, the Cochrane Library, Web of Science, Directory of Open Access Journals, and Google Scholar. The primary outcome was 24 h opioid consumption; secondary outcomes were duration of analgesia, pain scores, and complications. Data extraction and Risk of Bias assessment were performed independently by two reviewers. Continuous data were pooled as mean difference (MD) and dichotomous data as risk ratio with 95% confidence intervals (CIs). Analyses were conducted using Python (v3.11.13) and RevMan (v5.4).<h4>Results</h4>Ten randomised controlled trials (<i>n</i> = 777) were included in this meta-analysis. The risk of bias was low in 70% of studies, and none were at high risk. RIB reduced 24 h opioid consumption compared to control (no block) (SMD: -3.68; 95% CI: 5.13, 2.23; <i>P</i> < 0.00001) and serratus anterior plane block (SAPB) (SMD: -0.93; 95% CI: 1.65, -0.21; <i>P</i> = 0.01). There was no difference between RIB and pectoral nerve block or erector spinae plane block in terms of postoperative analgesic consumption. The duration of analgesia was significantly longer with the rhomboid intercostal block (RIB) compared to no block (MD: 8.84 h; 95% CI: 8.02, 9.66; <i>P</i> < 0.00001). The duration of analgesia was comparable between RIB and SAPB. Meta-analysis of postoperative pain scores was not feasible due to the limited number of studies. No block-related complications were reported in any of the studies. RIB reduced postoperative nausea and vomiting compared to control (no block), but not significantly when compared to other blocks.<h4>Conclusion</h4>RIB, as part of multimodal analgesia, significantly reduces opioid consumption compared with no block. RIB is a safe and effective alternative to established regional anaesthesia techniques for postoperative analgesia in breast surgeries.