The Effectiveness and Safety of Rhomboid Intercostal Block for Postoperative Pain Management in Thoracic and Breast Surgical Procedures: A Meta-analysis

Abstract

Background: The rhomboid intercostal block (RIB) is an emerging regional anesthesia (RA) technique used for pain control following thoracic and breast surgery. However, comprehensive documentation on its effectiveness and safety profile remains limited. This study aims to assess the effectiveness and safety of RIB in thoracic and breast surgical procedures. Methods: A study search was conducted following PRISMA 2020 guidelines in PubMed, Cochrane Library, Embase, Scopus, and ProQuest from 2016 to 2023 to identify randomized controlled trials (RCTs) evaluating the effectiveness and safety of RIB in thoracic and breast surgeries. The primary outcome was patient pain scores at rest, recorded at one, six, 12, and 24 hours post-surgery. Secondary outcomes included 24-hour opioid consumption and rates of postoperative nausea and vomiting (PONV). Results: This meta-analysis included five RCTs with a total of 368 patients. Rhomboid intercostal block led to a significant reduction in NRS scores one hour post-surgery (SMD = -1.33; 95% CI = -1.74 to -0.91; P < 0.00001, I² = 18%, P = 0.27), 12 hours post-surgery (SMD = -0.74; 95% CI = -0.99 to -0.48; P < 0.00001, I² = 36%, P = 0.21), and 24 hours post-surgery (SMD = -1.62; 95% CI = -2.56 to -0.69; P = 0.00006, I² = 91%, P < 0.00001). Regarding secondary outcomes, the RIB group showed a significant reduction in 24-hour opioid consumption (SMD = -4.49; 95% CI = -6.09 to -2.90; P < 0.00001, I² = 95%, P < 0.00001) and PONV rates (RR = -0.29; 95% CI = 0.18 to 0.47; P < 0.00001, I² = 0%, P = 0.88). Conclusions: Rhomboid intercostal block provides effective pain reduction and lowers opioid consumption within 24 hours post-surgery, while also minimizing PONV rates.