A Comparative Study between Ultrasound-guided Serratus Anterior Plane Block and Conventional IV Analgesics for Postoperative Pain Management in Modified Radical Mastectomy

Abstract

Background: Surgery is the first line of treatment for early, localized or operable breast cancer and it is associated with sever postoperative pain. Although opioids have been the mainstay for managing postoperative pain, they have undesirable side effects. A variety of methods, including thoracic epidural, paravertebral and intercostal blocks have been used to manage breast surgery pain; however each of these blocks has some drawbacks. Serratus anterior plane block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. This study compares between the effect of serratus anterior plane block and conventional IV analgesia on postoperative pain after modified radical mastectomy. Results: Postoperative pain scores were significantly lower in the SAPB group in the first 8 hours compared to the control group (P < 0.05), the time to the first rescue analgesic was significantly longer in the SAPB group with a mean 354 min compared to the control group; the mean is 17.8 min, the total dose of rescue analgesic was significantly lower in the SAPB group with a mean 50 mg in the first 24 hours compared to a mean of 212.5 mg in the control group. The patient’s satisfaction scores were higher, the incidence of postoperative nausea and vomiting was significantly lower among the SAPB group compared to the control group. No other complications were recorded in either group. Conclusions: The serratus anterior plane block can be used as one of the modalities in managing the pain of patients undergoing MRM surgery. This procedure was effective in reducing the need for postoperative opioids usage, better patient satisfaction with fewer side effects as; post-operative nausea and vomiting. It is simple and easy-to-learn technique.