Investigation of the Effects of Serratus Posterior Superior Intercostal Plane Block and Serratus Anterior Plane Block on Perioperative Analgesia Management in Patients Scheduled for Mastectomy

Mastektomi Planlanan Hastalarda Serratus Posterior Superior İnterkostal Plan Bloğu Ile Serratus Anterior Plan Bloğunun Peroperatif Analjezi Yönetimi Üzerine Etkilerinin Araştırılması

This study aims to evaluate and compare the analgesic efficacy of two ultrasound-guided regional anesthesia techniques, the serratus anterior plane (SAP) block and the serratus posterior superior intercostal plane (SPSIP) block, in patients undergoing elective mastectomy surgery. Postoperative pain following mastectomy is a common and significant clinical problem that negatively affects patient comfort, delays mobilization, and may prolong hospital stay. Although systemic analgesics are commonly used, they are associated with adverse effects such as sedation, constipation, and potential dependency.

In this randomized clinical study, female patients aged 18-75 years with ASA physical status I-III scheduled for elective mastectomy will be included after obtaining informed consent. Patients will be allocated into two groups to receive either SAP block or SPSIP block under ultrasound guidance prior to surgery. Standardized general anesthesia and perioperative analgesia protocols will be applied to all patients.

The primary objective is to compare postoperative pain scores between the two groups using the Numeric Rating Scale (NRS). Secondary outcomes include time to first analgesic requirement, total analgesic consumption, intraoperative opioid use, and hemodynamic parameters. By comparing these two interfascial plane blocks, this study aims to identify a more effective analgesic technique that improves postoperative pain control, enhances patient comfort, and facilitates early mobilization following mastectomy.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Pain; Mastectomy; Patient Outcome Assessment; Nerve Block
• Intervention / Treatment: Procedure: SAP Block; Procedure: SPSIP Block

Detailed Description

Postoperative pain following mastectomy surgery remains a significant clinical concern, as it negatively impacts patient comfort, delays recovery, and may prolong hospital stay. Effective pain management is essential not only to improve patient satisfaction but also to reduce complications associated with delayed mobilization. Although systemic opioids and other analgesics are frequently used, they are associated with adverse effects such as sedation, nausea, constipation, and risk of dependency. Therefore, regional anesthesia techniques have gained increasing importance as part of multimodal analgesia strategies.

Ultrasound-guided interfascial plane blocks, such as the serratus anterior plane (SAP) block and the serratus posterior superior intercostal plane (SPSIP) block, have been shown to provide effective analgesia for thoracic and breast surgeries by targeting similar dermatomal distributions. However, comparative data regarding their relative efficacy in mastectomy patients are limited. This study aims to compare these two techniques in terms of postoperative analgesia and recovery outcomes.

Female patients aged between 18 and 75 years, classified as ASA physical status I, II, or III, and scheduled for elective mastectomy will be included in the study after obtaining written informed consent. Patients will be randomly assigned into two groups.

In Group 1, patients will receive an ultrasound-guided SAP block using a linear probe under aseptic conditions. The block will be performed in the lateral decubitus position by advancing the needle between the second and seventh ribs to the plane beneath the serratus anterior muscle, and 30 mL of 0.25% bupivacaine will be administered.

In Group 2, patients will receive an ultrasound-guided SPSIP block under aseptic conditions in the sitting position. The needle will be inserted medially to the scapula between the second and seventh ribs, targeting the plane between the serratus posterior superior muscle and intercostal muscles, and 30 mL of 0.25% bupivacaine (maximum dose 2 mg/kg/day) will be administered.

All patients will undergo standardized general anesthesia, including induction with midazolam, lidocaine, propofol, fentanyl, and rocuronium, followed by maintenance with desflurane at 1 MAC. Standard intraoperative monitoring (heart rate, blood pressure, oxygen saturation, end-tidal CO₂, and ECG) will be applied. Intraoperative administration of paracetamol, tenoxicam, and granisetron will be performed routinely.

Hemodynamic parameters will be recorded at 30-minute intervals during surgery. Total intraoperative opioid consumption, duration of surgery, and anesthesia time will also be documented. At the end of surgery, neuromuscular blockade will be reversed with sugammadex.

Postoperative pain will be assessed by a blinded investigator using the Numeric Rating Scale (NRS) at 0, 30 minutes, and at 1, 2, 4, 8, 12, 24, 36, and 48 hours. Time to first analgesic requirement, additional analgesic use, and total consumption will be recorded.

Patients with NRS ≥4 will receive intravenous paracetamol as first-line rescue analgesia. If pain persists, intravenous opioid (1 mg/kg) will be administered as second-line rescue analgesia.

Secondary outcomes include postoperative complications, pain during first mobilization, and patient and surgeon satisfaction assessed using a 5-point Likert scale.

Statistical analysis will be performed using SPSS version 25. Normality of data will be assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Parametric or non-parametric tests will be used accordingly. Independent samples t-test or Mann-Whitney U test will be used for comparisons between groups, while paired t-test or Wilcoxon test will be used for within-group comparisons. ANOVA or Kruskal-Wallis tests will be used for comparisons involving more than two groups. A p-value <0.05 will be considered statistically significant.

This study is expected to determine the comparative effectiveness of SAP and SPSIP blocks in reducing postoperative pain, minimizing analgesic consumption, and improving recovery outcomes in patients undergoing mastectomy.

• Study Type: Interventional
• Enrollment (Estimated): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Nilüfer
    • Bursa, Nilüfer, Turkey (Türkiye), 16235
      • Recruiting
      • Bursa Uludag University Hospital
      • Contact: Muhammed A MOL, MD; Phone Number: +902242954476 +90 506 253 62 54; Email: malihanmol@uludag.edu.tr
      • Contact: Ali H Colak, MD; Phone Number: +902242953131 +90 506 560 35 17; Email: alihaydarcolak@uludag.edu.tr
      • Principal Investigator: Selcan Akesen, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Female patients aged between 18 and 75 years
• Patients scheduled for elective mastectomy surgery
• American Society of Anesthesiologists (ASA) physical status I-III
• Patients who provide written informed consent

Exclusion Criteria:

• Patients who refuse to participate in the study
• Patients with American Society of Anesthesiologists (ASA) physical status IV or V
• Patients receiving anticoagulant therapy or with suspected coagulopathy
• Patients with known allergy to local anesthetic agents
• Infection at the site of block application
• Pregnant patients or those with suspected pregnancy
• Patients with severe neurological or psychiatric disorders
• Patients with severe cardiovascular disease
• Patients with chronic opioid use
• Patients with hepatic failure or renal failure (glomerular filtration rate <15 mL/min/1.73 m²)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SAPB Group; Patients in this group will receive Serratus Anterior Plane Block for postoperative analgesia.	Procedure: SAP Block; Under ultrasound guidance with a linear probe, the needle is inserted along the posterior axillary line between the second and seventh ribs and advanced into the plane between the serratus anterior muscle and the rib surface. A total of 30 mL of 0.25% bupivacaine (maximum dose 2 mg/kg/day) is injected.
Experimental: SPSIPB Group; Patients in this group will receive Serratus Posterior Superior Intercostal Plane Block for postoperative analgesia.	Procedure: SPSIP Block; Under ultrasound guidance with a linear probe, the superomedial border of the scapula on the operative side is identified. The needle is inserted medial to the scapula between the second and seventh ribs and advanced into the interfascial plane between the serratus posterior superior muscle and the intercostal muscles. Subsequently, 30 mL of 0.25% bupivacaine (maximum dose 2 mg/kg/day) is administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Intensity	Postoperative pain intensity and time to first analgesic requirement will be evaluated. Pain will be assessed using the Numeric Rating Scale (NRS, 0-10) at 0 and 30 minutes, and at 1, 2, 4, 8, 12, 24, 36, and 48 hours postoperatively, both at rest and during movement, by a blinded investigator	Within 48 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Analgesic Consumption	Total consumption of additional analgesics (paracetamol and opioid) will be recorded.	Within 48 hours postoperatively
Additional Analgesic Requirement	The number of patients requiring additional analgesia and the frequency of administration will be recorded.	Within 48 hours postoperatively
Intraoperative Opioid Consumption	The total amount of opioids administered intraoperatively will be recorded.	During surgery
Intraoperative mean arterial pressure (mmHg)	Mean arterial pressure (mmHg) will be recorded at 30 minute intervals during surgery and summarized as mean values.	Every 30 minutes intraoperatively
Postoperative Complications	Postoperative complications such as nausea, vomiting or other adverse events will be recorded.	Within 48 hours postoperatively
Pain During First Mobilization	Pain during first mobilization will be assessed using the Numeric Rating Scale (NRS, 0-10), where 0 indicates no pain and 10 indicates the worst imaginable pain.	Within 48 hours postoperatively
Patient satisfaction score	evaluated using a 5-point Likert scale (1=very dissatisfied, 5=very satisfied)	At the 24th hour post-operation
Surgeon satisfaction score	The primary surgeon's satisfaction will the analgesia quality and ease of the procedure, evaluated using a 5-point Likert scale (1= very dissatisfied , 5= very satisfied)	Within 24 hours postoperatively

Collaborators and Investigators

• Sponsor: Uludag University

Publications and helpful links

General Publications

• Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Korkmaz AO, Bozkurt NN, De Cassai A, Torres AJ, Elsharkawy H, Alici HA. Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain. Cureus. 2023 Feb 3;15(2):e34582. doi: 10.7759/cureus.34582. eCollection 2023 Feb.
• Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth. 2017 May;61(5):381-386. doi: 10.4103/ija.IJA_62_17.
• Aslan G, Avci O, Gundogdu O, Isbir AC, Ozdemir Kol I, Kaygusuz K, Gursoy S. The effect of postoperative serratus anterior plane block on postoperative analgesia in patients undergoing breast surgery. Turk J Surg. 2020 Dec 29;36(4):374-381. doi: 10.47717/turkjsurg.2020.4744. eCollection 2020 Dec.

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2025
• Primary Completion (Estimated): September 15, 2026
• Study Completion (Estimated): October 15, 2026

Study Registration Dates

• First Submitted: March 19, 2026
• First Submitted That Met QC Criteria: March 29, 2026
• First Posted (Actual): April 3, 2026

Study Record Updates

• Last Update Posted (Actual): April 3, 2026
• Last Update Submitted That Met QC Criteria: March 29, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Serratus Anterior Plane Block; Multimodal Analgesia; Serratus Posterior Superior Intercostal Plane Block; Mastectomy Surgery
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: 25AKD131

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The individual participant data (IPD) will not be shared to protect patient privacy and confidentiality. The data collected for this study will only be used for the purposes of this specific research and will not be made available to other researchers to comply with institutional ethical guidelines.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No