Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial

Tan, Kok Wang; Masri, Syarifah Noor Nazihah Sayed; Musthafa, Qurratu Aini; Azidin, Azrin Mohd; Kamil, Amiruddin Nik Mohamed; Izaham, Azarinah; Nor, Nadia Md

doi:10.1097/md.0000000000030515

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…In the current study, we have chosen the superficial rather than the deep block, depending on the authors' experience and recommendations from previous studies. Tan et al [16] found that the superficial block achieved better analgesic efficacy for mastectomy with axillary clearance than the deep block, with lower pain scores, longer analgesic time, and reduced morphine consumption. This is probably explained by the need to extend the surgical incision to the lateral aspect of the hemithorax for axillary lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Bakeer,

Abdou,

Abdelhaleem

et al. 2024

Open Access Maced J Med Sci

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BACKGROUND: Post-operative pain after mastectomy is associated with poor recovery, prolonged hospital stays, and increased liability for chronic persistent pain. AIM: This work aimed to test the analgesic efficacy of adding ketamine to a dexamethasone bupivacaine combination in ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM). METHODS: This randomized, double-blind trial included 60 females aged 20–60 undergoing MRM. They were randomized into two groups: Group DB (n = 30) received SAPB using 30 ml of bupivacaine 0.25% and dexamethasone 4 mg. Group KD (n = 30) received the same block with the addition of ketamine 50 mg. RESULTS: The time to the first analgesic request was significantly delayed in Group KD than in Group DB (p < 0.001). The number of patients requiring morphine and its total consumption during the first 24 post-operative hours in Group KD were significantly less than in Group DB (p = 0.001 and p < 0.001, respectively). Visual Analog Scale scores at rest and movement at 4, 6, 8, 10, 12, and 18 h were significantly lower in Group KD than in Group DB. CONCLUSIONS: Adding ketamine to bupivacaine plus dexamethasone in ultrasound-guided SAPB is associated with better analgesic outcomes in patients undergoing MRM, including prolonged duration of analgesia and decreased post-operative morphine consumption and pain scores at rest and movement.

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Section: Discussionmentioning

confidence: 99%

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Bakeer,

Abdou,

Abdelhaleem

et al. 2024

Open Access Maced J Med Sci

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Efficacy and safety of the serratus anterior plane block (SAP block) for pain management in patients with multiple rib fractures in the emergency department: a retrospective study

Serra,

Santonastaso,

Romano

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Chest trauma is a severe and frequent cause of admission to the emergency department (ED). The serratus anterior plane (SAP) block seems to be an effective method of pain management; however, data on efficacy and safety of a single SAP block performed in the ED by emergency physicians (EP) are limited. This study aimed to compare SAP block performed by the EP in the ED plus standard therapy to standard therapy alone in terms of pain severity at 0-3-6-12-18 and 24 h, total opioid consumption (milligrams of morphine equivalents, MME), respiratory function (SpO2/FiO2 ratio), and adverse events (i.e. pneumothorax, infections in the site of injection, or Local Anaesthetic Systemic Toxicity syndrome due to SAP block) in the first 24 h. Methods This retrospective, monocentric study included adult patients admitted to the Sub-intensive Care Unit (SICU) of the ED with multiple rib fractures between 01/2022 and 03/2023. Results 156 patients (65.4% male; median age 62 years; median injury severity score 16; median thoracic trauma severity score 8) were included. 75 (48.2%) underwent SAP block. Patients undergoing SAP block showed significantly less pain 3–6–18 h after a single block, required less MME (0 [0–20] vs. 20 [0–40], p < 0.001), showed higher SpO2/FiO2 ratio, and no adverse events were reported. Conclusion The SAP block, in combination with standard therapy, appeared to be more effective in providing pain relief than standard therapy alone in patients admitted to the SICU for traumatic rib fractures.

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A Comparison of the Effectiveness of the Serratus Anterior Plane Block and Erector Spinae Plane Block to that of the Paravertebral Block in the Surgical Treatment of Breast Cancer—A Randomized, Prospective, Single-Blinded Study

But,

Wernicki,

Zieliński

et al. 2024

JCM

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Background/Objectives: The paravertebral block (PVB) is a well-studied, effective method of analgesia for breast surgery. Alternative techniques involving the blockage of intercostal nerve branches are the serratus anterior plane block (SAPB) and the erector spinae plane block (ESPB). However, no studies comparing both fascial blocks to PVB in breast surgery have been published to date. We evaluated the effectiveness of ESPB and SAPB vs. PVB, expressed as the requirement for intraoperative fentanyl, pain intensity at rest and during coughing, and morphine consumption on the first postoperative day. Additional aims were to perform an evaluation of the safety of the block types used. Materials and Methods: A total of 77 women and 1 man with stage I and II clinical breast cancer, aged 18–85 years, were randomized into one of three study groups: SAPB, PVB, and ESPB. Results: There were no statistically significant differences in fentanyl consumption during surgery with respect to the type of block used (p = 0.4246). Morphine consumption in the postoperative period was highest in the ESPB group, averaging 9.4 mg. There was a statistically significant difference in pain intensity from 4 pm on the day of surgery to 8 am the following morning. No complications related to the blocks were observed on the first postoperative day. Conclusions: Both the serratus anterior plane block and the erector spinae plane block were as effective as the paravertebral block in achieving intraoperative analgesia. The serratus anterior plane block was equally as effective as the paravertebral block in achieving postoperative analgesia. The erector spinae plane block was significantly less effective in achieving postoperative analgesia than both the paravertebral block and serratus anterior plane block.

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Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial

Cited by 3 publications

References 23 publications

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Efficacy and safety of the serratus anterior plane block (SAP block) for pain management in patients with multiple rib fractures in the emergency department: a retrospective study

A Comparison of the Effectiveness of the Serratus Anterior Plane Block and Erector Spinae Plane Block to that of the Paravertebral Block in the Surgical Treatment of Breast Cancer—A Randomized, Prospective, Single-Blinded Study

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