Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial

Abstract

Background: A larger volume of local anesthetic provides a wider range of blocked sensory but carries a greater risk. The purpose of this trial was to compare the effect of different volumes of ropivacaine injected to deep serratus anterior plane in patients undergoing breast surgery.Methods: In this randomized double-blind trial, 60 patients undergoing breast surgery were randomly allocated to R10, R20 and R30 groups (n=20), and received deep serratus anterior plane block with 10, 20 and 30 mL of 0.5% ropivacaine respectively. 30 minutes after block, the cutaneous sensory was tested by cold stimulus in the craniocaudal direction along the midaxillary line. We recorded the numerical rating scale pain scores over 24 h after surgery and estimated the area under curve by numerical rating scale pain scores. The cases of rescue analgesia and the prevalence of adverse events were also recorded.Results: The blocked dermatomes were 3 (3, 4), 6 (5, 7) and 7 (6, 8) in the R10, R20 and R30 groups, respectively (R10 vs. R20, P<0.001; R10 vs. R30, P<0.001; R20 vs. R30, P=0.005). The area under curve of R10 group was significantly higher compared with the R20 and R30 groups (P=0.014, P=0.003, at rest; P<0.001, P<0.001, on movement). Conclusions:The blocked dermatomes increased with increasing volume when 10, 20 and 30 mL ropivacaine was used for deep serratus anterior plane block. The analgesic effects of 20 and 30 mL were similar to each other and better than 10 mL. Therefore, in breast surgery, volume of 20 mL ropivacaine is considered to be appropriate for deep serratus anterior plane block.

Comparing ultrasound-guided serratus anterior plane block with erector spinae plane block for postoperative analgesia in thoracic and breast surgery: A systematic review and meta-analysis

“…Some studies recommend the use of 20 ml and 30 ml of 0.25% or 0.5% robivacaine [43,44]. Shi et al [45] revealed that in SAPB receiving different doses of ropivacaine for breast surgery, 0.5% ropivacaine 20 ml and 0.5% ropivacaine 30 ml could both meet the needs of postoperative analgesia after breast surgery, but 0.5% ropivacaine 10 ml could not provide su cient analgesia. In addition, Kunigo et al [46] revealed that 0.375% robivacaine 40 mL was more extensive than 20 mL.…”

Ultrasound-guided serratus anterior plane block for accelerated partial breast irradiation using multi-catheter interstitial brachytherapy technique under anesthesia in breast cancer patients: A case series

“…They have found a volume of 20 mL ropivacaine to be appropriate. [ 9 ] Huang et al . compared three concentrations as 0.375%, 0.5%, and 0.75% of ropivacaine in SAP block.…”

The effect of different nerve block strategies on the quality of post‐operative recovery in breast cancer patients: A randomized controlled study

“…Breast cancer is a prevalent disease that affects both physical and mental well‐being due to post‐operative acute pain, which impairs the quality of post‐operative recovery (Hu et al, 2021; Shi et al, 2021). Post‐operative acute pain resulting from partial or total breast removal may lead to chronic pain in the long term.…”

“…Currently, there are various nerve block analgesia methods for post‐operative patients who undergo breast removal (Hu et al, 2021). Paravertebral nerve block, serratus anterior plane block, modified serratus anterior plane block, pectoral nerve block I (Pecs I), modified pectoral nerve block II (Pecs II), transverse thoracic muscle plane blocks (TTMPB) and serratus‐intercostal plane block (SIPB) can all be applied as post‐operative analgesia for breast removal (Abdallah et al, 2021; Albi‐Feldzer et al, 2021; Gabriel et al, 2021; Shi et al, 2021); they can all reduce post‐operative pain in patients, decrease opioid consumption during and after surgery and enhance the quality of post‐operative recovery to some extent (Albi‐Feldzer et al, 2021; Hu et al, 2021; Mazzinari et al, 2019; Xiao et al, 2021). However, there is no conclusive evidence to prove the best nerve block analgesia method for breast cancer removal (Albi‐Feldzer et al, 2021; Singh et al, 2022; Stokes et al, 2022), and the effect of different methods on the quality of post‐operative recovery is unclear.…”