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Abstract
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Background and Aims Several interfascial plane blocks have been described in patients undergoing modified radical mastectomy (MRM). However, the most efficacious technique is not known. So, we conducted this study to evaluate the analgesic efficacy of ultrasound guided serratus anterior plane (SAP) block and erector spinae plane (ESP) block in patients undergoing MRM.
Methods 80 female patients (18-70 years) undergoing MRM were randomized to two groups of 40 each and given ultrasound guided SAP block or ESP block with 0.4ml/kg of 0.375% ropivacaine in this prospective double-blind control trial. The groups were compared for the time to first dose of rescue analgesic, requirement of rescue analgesics and patient satisfaction score.
Results The time to first rescue analgesia was significantly prolonged in SAP group as compared to ESP group (p=0.03). The probability of a patient being pain-free (NRS<3) was significantly higher in SAP group than ESP group. Postoperative pain scores at rest at 0 minute was significantly lower in SAP group as compared to ESP group. The intraoperative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable between the two groups. The number of patients requiring rescue doses of fentanyl intraoperatively and rescue analgesics postoperatively were similar in both the groups. The mean patient satisfaction score was also comparable in both groups.
USG images showing needle tip and drug deposition in SAP and ESP block
Conclusions Ultrasound guided SAP block significantly prolonged the time to first rescue analgesia and a small trend toward lower requirement of rescue analgesics and better patient satisfaction as compared to ESP block in patients undergoing MRM.