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Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial
  1. Guido Mazzinari1,2,
  2. Lucas Rovira3,
  3. Alma Casasempere1,
  4. Juan Ortega1,
  5. Luis Cort1,
  6. José-Miguel Esparza-Miñana1,2,4 and
  7. Moncef Belaouchi1
  1. 1 Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
  2. 2 Research Group in Perioperative Medicine, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
  3. 3 Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
  4. 4 Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir. C/Guillem de Castro, 65, Valencia, Spain
  1. Correspondence to Guido Mazzinari, Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia 46940, Spain; gmazzinari{at}


Background and objectives In the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.

Methods This double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.

Results Median 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).

Conclusions Interfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.

Trial registration number NCT02905149.

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  • Presented at Interim data from this work were presented at the Euroanaesthesia 2017: The European Anaesthesiology Congress in Geneva, 3–5 June 2017, and published in a supplement to the European Journal of Anaesthesiology (2017;34:Supplement e55:08AP03-1).

  • Funding This research was funded by an internal grant from the Instituto de Investigación Sanitaria La Fe, Valencia, Spain.

  • Patient consent Patient gave their written informed consent prior to study enrolment

  • Ethics approval Hospital’s Institutional Review Board.