Efficacy of serratus anterior muscle block as a part of multimodal analgesic regimen in patients undergoing modified radical mastectomy

Abstract

Background: The quest for optimal analgesia after modified radical mastectomy has made anaesthesiologist steer its way into the arena of ultrasound guided interfascial blocks. Providing round the clock post-operative analgesia is standard care of treatment provided in our institution to enhance early recovery and prevent morbidity secondary to chronic pain syndromes. We hypothesised that administering serratus anterior muscle (SAM) block as a part of multimodal analgesia would be more efficacious in providing post-operative pain relief than intravenous patientcontrolled analgesia (IV-PCA) alone in patients undergoing modified radical mastectomy (MRM). Methods: After obtaining the institutional ethics committee approval and written informed consent, 60 females with American Society of Anaesthesiology (ASA) physical status I and II, aged between 20-80 years, scheduled to undergo MRM under general anaesthesia were randomized to receive post-operative IV-PCA with or without ipsilateral SAM block administered in the study group just after induction. The data was analysed for all quantitative variables and measures of dispersion. Normality of data was ascertained, and appropriate statistical tests were applied. Results: The mean pulse, blood pressure and VAS (at rest and movement) was found to be significantly higher at all time intervals in the group not receiving SAM block. Also, the total morphine dose, rescue analgesic consumption as well incidence of post-operative nausea and vomiting was higher in group that received IV-PCA only in the post-operative period. Conclusions: We conclude that post induction, single shot ultrasound guided ipsilateral serratus anterior muscle block provides effective post-operative analgesia in patients undergoing modified radical mastectomy than IV-PCA alone.

Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…The years of publication of these studies ranged from 2017 to 2021, and the sample size ranged from 40 to 116. Overall, 7 trials, 5 trials, and 1 trial used bupivacaine [ 26 , 27 , 30 , 32 , 34 , 36 ], ropivacaine [ 12 , 29 , 33 , 35 , 37 ], and levobupivacaine [ 28 ] as a local anaesthetic, respectively. The volume of the local anaesthetic was 20–40 mL, and its concentration was 0.25%–0.5%.…”

“…A total of 10 trials used the random sequence generation method [ 12 , 27 – 37 ], 9 trials explained the allocation concealment [ 12 , 26 , 28 , 30 , 33 , 35 , 36 ], 3 trials explicitly described the method of double blinding [ 12 , 28 , 36 ], and 9 trials described blinded assessors and evaluated attrition bias [ 12 , 27 , 28 , 31 , 33 – 37 ]. There was no selective reporting.…”

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

“…No significant difference was shown 6 h after surgery, probably due to the limited number of included studies. Additionally, 24 studies analyzed postoperative movement or cough pain scores with the use of SAPB in patients undergoing thoracic or breast surgery [4,5,15,16,[30][31][32][33][34][35][36][37][38]. Metaanalysis showed that compared with the control group, the SAPB group showed significantly reduced movement or cough pain scores at different postoperative time points, except for 48 h postoperatively (Figures 5-7…”

“…Nineteen studies reported 24 h postoperative opioid consumption in patients undergoing thoracic or breast surgery [5,15,16,32,33,[36][37][38][45][46][47][48]. Meta-analysis showed that SAPB significantly reduced 24 h postoperative opioid consumption compared with the control group (Figure 8) (SMD, −2.77; 95% CI, −3.56 to −1.97; P < 0.01; I 2 = 97%).…”