Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial

Abstract

BackgroundParavertebral and serratus plane blocks are both used to treat pain following breast surgery. However, it remains unknown if the newer serratus block provides comparable analgesia to the decades-old paravertebral technique.MethodsSubjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection serratus or paravertebral block in a subject-masked fashion (ropivacaine 0.5%; 20 mL unilateral; 16 mL/side bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room with serratus blocks (measurement: Numeric Rating Scale), and (2) opioid consumption would be non-inferior with serratus blocks in the operating and recovery rooms. In order to claim that serratus blocks are non-inferior to paravertebral blocks, both hypotheses must be at least non-inferior.ResultsWithin the recovery room, pain scores for participants with serratus blocks (n=49) had a median (IQR) of 4.0 (0–5.5) vs 0 (0–3.0) for those with paravertebral blocks (n=51): 0.95% CI −3.00 to −0.00; p=0.001. However, the difference in morphine equivalents did not reach statistical significance for superiority with the serratus group consuming 14 mg (10–19) vs 10 mg (10–16) for the paravertebral group: 95% CI −4.50 to 0.00, p=0.123. Since the 95% CI lower limit of −4.5 was less than our prespecified margin of −2.0, we failed to conclude non-inferiority of the serratus block with regard to opioid consumption.ConclusionsSerratus blocks provided inferior analgesia compared with paravertebral blocks. Without a dramatic improvement in safety profile for serratus blocks, it appears that paravertebral blocks are superior to serratus blocks for postoperative analgesia after non-mastectomy breast surgery.Trial registration numberNCT03860974.

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

“…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.…”

Metabolomic Impact of Lidocaine on a Triple Negative Breast Cancer Cell Line

“…Lidocaine is a commonly used local anesthetics which is often required for local anesthesia before performing fine needle aspiration biopsy or core needle biopsy. It is also employed for regional anesthesia in breast cancer surgery, remote from the surgical site when performing paravertebral block or closer to the wound through plane blocks (pectoral nerves block, serratus blocks, erector spinae plane block … ) ( Elshanbary et al, 2021 ; Gabriel et al, 2021 ).…”

The association of Serratus Anterior Plane blocks with postoperative opioid use and analgesia following simple lumpectomy: a retrospective cohort analysis

“…The SAP block targets lateral cutaneous branches of intercostal nerves T2-T9 as they pass superficial or deep to the serratus anterior muscle in the lateral chest wall [12] and innervates the anterolateral chest wall. The efficacy of this block for breast surgery has been investigated, particularly when compared to paravertebral (PVB), PECS and ESP blocks [13][14][15][16][17].…”