Comparative randomized study of continuous serratus anterior plane block versus continuous paravertebral block in post-mastectomy pain

Abstract

Background Many analgesic methods have been used to control post-mastectomy pain. Both thoracic paravertebral and serratus anterior blocks are recent regional techniques with promising results. The aim of this study was to compare safety and analgesic efficacy of both techniques in controlling post-mastectomy pain. Methods The study was conducted from January 1, 2019, till January 10, 2019, on 60 female patients ASA class ≤ 2 undergoing modified radical mastectomy. After induction of balanced general anesthesia patients received either continuous thoracic paravertebral block (group P) or continuous serratus anterior block (group S). Twenty milliliters of levobupivacaine 0.25% were injected in each technique under ultrasound guidance followed by continuous infusion of 5 ml/h levobupivacaine 0.125% through a 22-gage catheter. IV morphine was given postoperatively by patient-controlled analgesia. In both groups, we measured time to first dose morphine, total 24 and 48 h morphine consumption, vital signs, visual analog scale, and side effects of each technique. Results The demographic data (age, body mass index, and duration of surgery) were comparable in both groups. The time for first dose of morphine was significantly longer in group P (368 ± 36 min) than group S (270 ± 37.65 min) with P value < 0.001. Total morphine consumption in milligram at both 24 and 48 h were significantly less in group P (8.1 ± 0.8, and 11.5 ± 1 respectively) than in group S (10.1 ± 1.3 and 14.2 ± 1.4), with limited side effects in both groups. Conclusion Both continuous paravertebral and serratus anterior plane blocks are safe good alternatives to control post-mastectomy pain. However continuous paravertebral block provides better analgesic profile.

A randomized controlled study comparing thoracic paravertebral block to serratus anterior plane block in breast surgery

“…In addition, pectoralis major muscle is supplied by pectoral nerves which are branches from brachial plexus not thoracic nerves explaining the pain with abduction of the arm. [16,19] There was significant tachycardia in the SAPB group in the intraoperative, immediately postoperative and 2 hours postoperative with p value 0.001, 0.004 and 0.001 respectively.…”

“…VAS scores postoperatively were comparable in the two groups, also postoperative morphine consumption in the 24 hrs was significantly higher in the SAPB group vs the TPVB group [9.7 ± 2.1 mg vs 6.5 ± 1.5, P < 0.001,]. Mahran et al, [16] compared ultrasound guided continuous SAPB and continuous TPVB for pain relief following MRM with axillary dissection. They found that the time for the first analgesic drug request was significantly increased in TPVB 368 ± 36.0 min vs 270.2 ± 37.7 for SAPB p < 0.001.…”

Efficacy of Serratus Anterior Plane Block vs Paravertebral and Intercostal Blocks for Pain Control after Surgery

“…We finally excluded 5 studies and identified 16 RCTs in this systematic review and meta-analysis. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] One study 20 did not report data amenable for a pooled analysis and hence was not included.…”

“…The included studies are shown in Table 1. Thirteen studies [19][20][21][22][23][24]27,[29][30][31][32][33][34] compared SAB versus PVB, whereas only 3 studies 25,26,28 compared SAB with ICB. Of the total 16 studies, 5 each were conducted in India and Egypt.…”

“…However, in 4 of the studies, 23,26,28,29 one of the interventions or comparative group block was administered after surgery, whereas in 2 studies, 25,32 both the blocks were administered after surgery. All studies used a single block except for 3 studies 23,24,29 comparing SAB with PVB wherein continuous infusions were used. The baseline analgesia protocol was variable across the included studies.…”