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Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial
  1. Başak Altıparmak1,
  2. Melike Korkmaz Toker1,
  3. Ali Ihsan Uysal2,
  4. Özcan Dere3 and
  5. Bakiye Uğur1
  1. 1 Anesthesiology, Muğla Sıtkı Koçman University, Muğla, Turkey
  2. 2 Anesthesiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
  3. 3 General Surgery, Muğla Sitki Koçman University, Muğla, Turkey
  1. Correspondence to Dr Başak Altıparmak, Anesthesiology, Mugla Sitki Kocman Universitesi, Muğla 48000, Turkey; basak_ugurlu{at}


Background and objectives Mastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia.

Methods Patients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I–II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room.

Results The descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4–7 mg) in group R and 10 mg (IQR 8–13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups.

Conclusions In the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery.

Trial registration number ACTRN12619000879167.

  • acute pain
  • interventional pain management
  • postoperative pain
  • ultrasound in pain medicine
  • pain outcome measurement

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  • Contributors BA, MKT, AU and BU contributed to the study design. BA, MKT and AU recruited study patients after randomization. AU, MKT and ÖD collected study data. BA, MKT, AU and ÖD contributed to statistical analysis. All the authors drafted the manuscript and reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study got ethical approval from the Institutional Ethical Committee of Muğla Sıtkı Koçman University Clinical Trials Ethical Committee in accordance with the principles outlined in the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data will be available (following deidentification of the participant data) on request via email to the corresponding author (email: