Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial

Abstract

Background and objectivesIn the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.MethodsThis double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.ResultsMedian 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).ConclusionsInterfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.Trial registration numberNCT02905149.

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

“…The PECS 2 block reduced median (IQR [range]) morphine consumption in the first 24 h from 6 (3-9 [1-25]) mg after the serratus plane block to 4 (2-7 [0-37]) mg, p = 0.04. However, acute pain scores after serratus plane and PECS 2 blocks were similar, median (IQR [range]) 23 [0-70]) mm vs. 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) [0-61]) mm, respectively, p = 0.44.…”

“…These blocks are effective for acute postmastectomy pain [20][21][22][23][24][25][26] and improve persistent postmastectomy pain [29,30]. However, it is uncertain which block is more effective.…”

“…We recorded morphine consumption in the first 24 postoperative hours. A physician, unaware of allocation, telephoned participants six months after surgery to assess pain on an 11-point numerical rating scale (NRS), defined as: 1-3, mild pain; 4-6, moderate pain; and 7-10, severe pain [26]. We decided NRS ≥ 4 would interfere with participants' mood and activity [27].…”

“…Both thoracic interfascial plane blocks reduce acute pain after mastectomy [20][21][22][23][24][25][26]. However, the long-term analgesic effects remain unclear.…”

<p>Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial</p>

“…analgesia over conventional analgesia in breast cancer patients undergoing mastectomies. 16 In a case series of 11 patients undergoing mastectomies with axillary lymph node dissection and breast reconstruction with flap, Khemaka and colleagues reported that SAPB is an effective analgesic technique that improves perioperative pain and reduces postoperative opioid consumption. 15 Similarly, Rahimzadeh and colleagues studied the effect…”