<p>Modified Pectoral Nerve Block versus Serratus Block for Analgesia Following Modified Radical Mastectomy: A Randomized Controlled Trial</p>

Abstract

Background Modified pectoral nerves (PECSII) and serratus blocks have been recently used for analgesia in breast surgery, but evidence comparing their analgesic benefits is limited. This prospective randomized, controlled study aims to examine the analgesic efficacy and safety profile of ultrasound-guided PECSII versus serratus blocks in patients undergoing modified radical mastectomy (MRM) for breast cancer. Patients and Methods One-hundred and eighty adult females scheduled for MRM were randomly allocated to three groups. PECS group patients received a PECSII block with 30mL of bupivacaine 0.25%, whereas SAPB group received a serratus anterior plane block (SAPB) using the same volume of bupivacaine 0.25% before induction of anesthesia. The control group received general anesthesia alone. Outcomes included 24 hours morphine consumption, intraoperative fentanyl requirements, visual analogue scale (VAS) scores for pain at rest and during movement, time to first rescue analgesia, postoperative nausea and vomiting (PONV), and sedation scores. Results Both PECSII and serratus blocks were associated with reduced postoperative morphine consumption compared to the control group (p<0.001). Both blocks were associated with reduced intraoperative fentanyl requirements, VAS scores, and PONV as compared with the control group. Also, they were associated with prolonged time to first rescue analgesia and better sedation scores in comparison with the control group. However, there were no differences between both blocks for all outcomes. Conclusion PECSII and serratus blocks provide similarly adequate analgesia following modified radical mastectomy. Clinical Trial Registration NCT02946294.

A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

“…It is a new type of peripheral fascial nerve block. By injecting anesthetics into the muscle space of the chest wall, the thoracic nerve depends on the diffusion of the drug to achieve an analgesic effect (15). PECS block can block the intercostal nerve, the intercostal brachial nerve, the lateral cutaneous branch of the intercostal nerve, the medial cutaneous nerve of the arm and forearm, the long thoracic nerve, and the thoracic dorsal nerve; however, it cannot block the anterior cutaneous branch of the intercostal nerve (16).…”

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

“…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.…”

Anesthetic effect of ultrasound-guided multiple-nerve blockade in modified radical mastectomy in patients with breast cancer

“…There are reports in which the nerve block of anterior serratus and the modified pectoral nerve block can be used in the postoperative analgesia of modified radical mastectomy. [ 20 , 21 ] Accordingly, compared with the GA, anterior serratus nerve block or modified pectoral nerve block is superior with respect to the analgesic effect, owing to the less involvement of the puncture points, and less discomfort in the patients. Nonetheless, there is no report on the use of anterior serratus nerve block or modified thoracic nerve block alone for modified radical mastectomy.…”