Women undergoing mastectomy surgery often experience severe postoperative
pain and may develop into chronic pain.
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.
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.
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.