Comparison of serratus plane block alone and in combination with pectoral type 1 block for breast cancer surgery: a randomized controlled study

Abstract

Background/aim: Concurrent application of ultrasound-guided pectoral type 1 (PECS I) and serratus plane block (SPB) is one of the most appropriate multimodal analgesic strategies for reducing acute post-mastectomy pain. The purpose of the present study was to compare the analgesic efficacy of SPB alone, or in combination with PECS I block for post-mastectomy pain following breast cancer surgery.

Materials and methods: Sixty participants undergoing breast cancer surgery were randomly assigned to two groups. After anesthesia induction, group S (n =30) received SPB alone, whereas the SPECS group (n =30) received a combination of PECS I and SPB. Pain scores at 0, 1, 2, 6, 12, 24 h postoperatively, intra-operative fentanyl consumption, postoperative time to first rescue analgesia, nausea, vomiting, patient satisfaction, and anesthesia-related complications were recorded.

Results: Pain scores in the SPECS group were significantly lower than group S throughout the follow-up period (p <0.001). A significant reduction in postoperative rescue morphine consumption (p =0.01, median difference 7 mg, 95 % confidence interval: 5.1-7.9 mg) and intraoperative fentanyl consumption (p =0.01) in the SPECS group compared with group S. Moreover, postoperative nausea and vomiting were lower, and patient satisfaction was higher in the SPECS group compared with that of the group S.

Conclusions: These results suggest that SPB application and PECS I provide more effective and reliable perioperative analgesia and increase patient satisfaction in breast cancer surgery. HIPPOKRATIA 2021, 25 (1):8-14.

Trial registration number: NCT03899545.

Keywords: Acute pain management; breast cancer surgery; bupivacaine; pectoral type 1 block; serratus plane block.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Copyright 2021, Hippokratio General Hospital of Thessaloniki.

Figures

Figure 1. Pectoral 1 block and serratus plane block. A) Position of the needle before performing the pectoralis 1 block. B) Ultrasound images of the pectoral 1 block application of local anesthetic drug between pectoral major and minor muscle. C) Position of the needle before performing the serratus plane block. D) Ultrasound images of the serratus plane block application of local anesthetic drug superior to the serratus muscle. PMm: pectoralis major muscle, Pmm: pectoralis minor muscle; SAM: serratus anterior muscle.

Figure 2. Flow diagram of participant recruitment according to the CONSORT statement.

Figure 3. Box plots of postoperative numeric rating scale (NRS) pain scores in each group over the first 24 postoperative hours. The horizontal color line in each box represents the median value, the outer margins of the box represent the interquartile range, and the whiskers represent the 10th and 90th percentile for each time point. NRS: numeric rating scale (0 to 10 scale), Group S: patients received serratus plane block alone, Group SPECS: patients received a combination of pectoral type 1 and serratus plane block