This study investigated if the serratus anterior plane block (SAPB) within a multimodal analgesia scheme would reduce acute post-operative pain and intravenous opioid consumption in patients admitted to the intensive care unit after isolated minimally invasive mitral valve surgery.Retrospective study.Patients were admitted to the intensive care unit (ICU) of the University Hospital of Siena (Italy).Patients treated with intravenous opioids (OP-G) as a postoperative analgesic regimen were compared to those managed with an opioid-sparing protocol consisting of a single-shot SAPB with 0.5% ropivacaine plus 4 mg dexamethasone administered 1 hour before the extubation (SAPB-G). The behavioral pain scale (BPS) for intubated (I) or non-intubated patients (NI) and the Richmond Agitation Sedation Scale (RASS) scores were collected at ICU admission and every 8 hours during the initial 24 postoperative hours.One hundred five patients (50 SAPB-G; 55 OP-G) were enrolled (median age 67 [60-70]; male 67 [64%]). RASS score at 8 hours after ICU admission was higher in the SAPB-G (0 [0, 0] v OP-G -2 [-3, 0], p 4 was lower in the SAPB-G (4.0% v 18.2% OP-G, p = 0.048). SAPB-G received a lower number of opioid rescue doses during the first 24 hours (20% v 84% OP-G, p < 0.001).The SAPB may be effective in reducing the postoperative use of opioids in patients undergoing minimally invasive mitral valve surgery. Prospective randomized studies are warranted.