Comparison of Serratus Anterior Plane Block by Anatomical Landmark-Guided Technique Versus Ultrasound-guided Technique for Gynaecomastia Surgery: A Randomized Controlled Trial

Abstract

Background: Breast surgeries are common surgical procedures and postoperative pain after mastectomy is a major concern as inadequate pain relief can result in chronic pain and reduced quality of life. Serratus anterior plane (SAP) block is suitable for perioperative analgesia for gynaecomastia correction surgery. Objectives: To compare postoperative pain relief using the VAS and D-VAS scores between anatomical landmark-guided SAP block and ultrasound-guided SAP block in patients undergoing surgery for gynecomastia correction. Methods: Patients aged 16-40 years, belonging to American Society of Anaesthesiologists (ASA) physical status I or II who were scheduled for gynaecomastia correction surgery were randomized and allocated into two groups. Group I (n = 15) patients received 20 ml of 0.25 % bupivacaine solution with 20 μg of Fentanyl by anatomical landmark-guided SAP technique while Group II (n = 15) patients in the control group received same drug using ultrasound-guidance technique. VAS and D-VAS from arrival to post anaesthesia care unit (PACU), then after 30 minutes, and at 1 hour, 2 hours, 6 hours, 12 hours, 18 hours, and 24 hours. Results: Both groups had comparable results in terms of pain scores at different time intervals, duration of analgesia (615 mins vs 706 mins) and need for rescue analgesics. Conclusion: Anatomical landmark-based SAP block technique is comparable to the ultrasound-guided SAP block technique in terms of efficacy and duration of analgesia with lesser complications. The former can serve as an alternative to the latter technique in resource-limited countries.