<p>Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial</p>

Abstract

Background: Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective: This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods: Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra-and postoperative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results: In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion: Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration: The registration number of this study is NCT02962024 at www.clinicaltrial. gov.

Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis

“…SAPB inhibits lateral and anterior cutaneous branches that come from the second to sixth intercostal nerves [ 21 ]. Southgate found that SAPB is recommended for conditions requiring pain management, including thoracotomy, breast surgery, and postmastectomy pain syndrome [ 22 ].…”

“…Figure 2a and 2b illustrates the risk of bias evaluation for the selected studies. Random allocation was applied in almost all included trials [ 10 , 12 , 19 , 21 , 22 ], except in one trial [ 9 ]. Bias from intended interventions was low due to the awareness of participants and people delivering the intervention.…”

Effect of Ultrasound-Guided Fascia Iliac Compartment Block with Nalbuphine and Ropivacaine on Preoperative Pain in Older Patients with Hip Fractures: A Multicenter, Triple-Blinded, Randomized, Controlled Trial

“…Nalbuphine is an opioid agent with μ antagonist and κ agonist properties. Studies have shown that opioids as an adjuvant improved the analgesic effects of local anesthetics [ 29 , 30 ]. In this study, we found that UGFICB with ropivacaine plus nalbuphine prolonged the analgesia duration at rest and on passive movement, which is consistent with previous reports [ 15 ].…”