Background <p>Effective pain management for rib fractures is crucial to prevent pulmonary complications and facilitate recovery. UGPB has emerged as a promising regional analgesic technique for these patients.</p> Objective <p>This systematic review with meta-analysis aims to evaluate the effectiveness of UGPB compared with standard care for managing pain associated with rib fractures. In this review, the term UGPB serves as an umbrella term for various UGPBs, with the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) being the two specific techniques evaluated in the included studies.</p> Methods <p>This study conducted a comprehensive search of electronic databases including PubMed, Embase, Cochrane Library, Web of science and China National Knowledge Infrastructure (CNKI) up to 31 March 2026. Eligibility criteria were established based on the inclusion of adult patients diagnosed with rib fractures treated with UGPB versus standard care. The primary outcome was pain intensity, assessed using a Visual Analog Scale (VAS) or Numeric Rating Scale (NRS). Secondary outcomes included total amount of analgesic consumption, respiratory function (PaO₂ and PaCO₂ via arterial blood gas analysis), and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias (RoB 2) tool. The certainty of evidence for primary outcomes was assessed using the GRADE framework. Continuous outcomes were pooled as standardized mean differences (SMD) with 95% confidence intervals using a random-effects model; heterogeneity was assessed via I².</p> Results <p>Nine randomized controlled trials (RCTs) involving 664 participants were included. Most studies raised some concerns regarding risk of bias, primarily related to the randomization process, allocation concealment, or blinding of participants and personnel; four studies were judged to be at high overall risk of bias, and none at low risk. The pooled data from 7 studies (423 participants) showed that UGPB significantly reduced pain scores (SMD = -0.44, 95% CI: -0.72 to -0.16; I² = 51%; <i>p</i> &lt; 0.01). A leave-one-out sensitivity analysis for pain scores (excluding one study at a time from the 7 included studies) yielded SMDs ranging from − 0.49 to -0.38 (all <i>p</i> &lt; 0.05) and I² ranging from 45% to 58%, confirming the robustness of this finding. For respiratory parameters, based on 3 studies (198 participants) there were no significant differences in PaCO₂ levels (SMD = -0.02, 95% CI: -0.56 to 0.61; I² = 75%; <i>p</i> = 0.95). PaO₂ levels remained stable (SMD = 0.04, 95% CI: -0.24 to 0.32; I² = 0%; <i>p</i> = 0.78). The effect on analgesic consumption, from 7 studies (546 participants), was not significant (SMD = -0.09, 95% CI: -1.61 to 1.43; I² = 96%; <i>p</i> = 0.91). The certainty of evidence was low for pain scores and very low for analgesic consumption and blood gas parameters according to GRADE.</p> Conclusion <p>UGPB reduces pain scores in patients with rib fractures, with a small-to-moderate effect size (SMD = -0.44, 95% CI: -0.72 to -0.16), and does not appear to compromise respiratory function based on stable PaCO₂ and PaO₂ levels. However, given the concerns regarding risk of bias and heterogeneity, these findings should be interpreted cautiously. High heterogeneity in analgesic consumption and other outcomes underscores the need for further high-quality research to standardize protocols and optimize the use of UGPB in clinical practice.</p> PROSPERO registration <p>CRD420251077539 (registered 20 June 2025) </p>