The effect of ultrasound-guided superficial serratus plane block for acute postmastectomy pain after modified radical mastectomy and axillary lymph node dissection: A randomized controlled study

Abstract

Objective: Breast cancer is the most common type of cancer affecting women. Every year thousands of patients undergo surgery from breast and axillary region. Extremely severe acute postoperative pain occurs during this surgery. In recent years together with increasing use of ultrasound in regional anesthesia practice, plane blocks have become popular in anesthesiology practice. One of them is the serratus plane block (SPB) defined by the dissemination of local anesthetic superficial or deep to the serratus muscle. The aim of this study is to investigate the effect of superficial SPB on postoperative opioid consumption in patients who would undergo modified radical mastectomy and axillary lymph node dissection. Methods: After ethics committee approval,48 patients, aged 18-65 years, undergoing ASA I-III modified radical mastectomy, and axillary lymph node surgery were randomized into 2 groups. Control Group (Group C, n=24); received ultrasound-guided subcutaneus injection of 2 mL 0.9% saline before the surgery, Group SPB (Group S, n=24) received ultrasound-guided injection of 0.25 % bupivacaine 30 mL on the serratus muscle. Postoperatively, patient-controlled analgesia was performed intravenously in the 2 groups at 12 hour-intervals with 50 mg dexketoprofen trometamol and fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Opioid consumption, requirement for additional analgesia and opioid related side effects were recorded during the first 24 hours after surgery. Results: The 24-hour opioid consumption was significantly lower in the SPB group compared with the control group (123.96±72.04 mcg vs 345.83±207.56 mcg, p<0.001). Compared with the control group, the VAS score was statistically lower in the SPB group at all measurement time points (P<0.05). Requirement for rescue analgesia was statistically lower in the SPB group than the control group (3/24 vs 9/24, p<0.046). Conclusion: Superficial SPB can be used safely in the management of pain for modified radical mastectomy and axillary lymph node surgery as it is easy to perform, provides excellent analgesia and reduces opioid consumption.