Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for postmastectomy analgesia

Abstract

Background Women undergoing mastectomy surgery often experience severe postoperative pain and may develop into chronic pain. Objective The current study compared the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) with thoracic paravertebral block (TPVB) for controlling acute postmastectomy pain. Patients and methods This prospective study was conducted on 60 female patients undergoing mastectomy surgery. Patients were randomized into two groups: the TPVB) group (n=30) included patients who received paravertebral block at T4 with 20 ml of bupivacaine 0.25% and adrenalin 5 µg/ml and the SAPB group (n=30) patients who received serratus intercostal plane block with 0.4 ml/kg bupivacaine 0.25% plus adrenalin 5 µg/ml. Both performed as single injection at the end of surgery. Postoperative visual analog scale pain scores, time to first analgesic requirement, total dose of rescue analgesic, hemodynamic parameters, and incidence of postoperative nausea and vomiting were all recorded. Results Visual analog scale scores were significantly lower in the SAPB group compared with the TPVB group at 12th and 16th hour postoperatively. The total dose of rescue analgesic was significantly lower in SAPB compared with the TPVB. Time to the first analgesic dose was significantly longer in the SAPB compared with the TPVB. There was no significant difference between the study groups regarding the hemodynamic parameters and incidence of postoperative nausea and vomiting. Conclusion Both SAPB and TPVB provide adequate analgesia for breast surgeries, but the current study found that SAPB superior to TPVB in terms of delayed requirement for the first rescue analgesia and 24 h reduced analgesic consumption, indicating that SAPB is a feasible and effective method for pain treatment after breast surgery.