Background Paravertebral and serratus plane blocks are both used to treat pain following breast surgery. However, it remains unknown if the newer serratus block provides comparable analgesia to the decades-old paravertebral technique.
Methods Subjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection serratus or paravertebral block in a subject-masked fashion (ropivacaine 0.5%; 20 mL unilateral; 16 mL/side bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room with serratus blocks (measurement: Numeric Rating Scale), and (2) opioid consumption would be non-inferior with serratus blocks in the operating and recovery rooms. In order to claim that serratus blocks are non-inferior to paravertebral blocks, both hypotheses must be at least non-inferior.
Results Within the recovery room, pain scores for participants with serratus blocks (n=49) had a median (IQR) of 4.0 (0–5.5) vs 0 (0–3.0) for those with paravertebral blocks (n=51): 0.95% CI −3.00 to −0.00; p=0.001. However, the difference in morphine equivalents did not reach statistical significance for superiority with the serratus group consuming 14 mg (10–19) vs 10 mg (10–16) for the paravertebral group: 95% CI −4.50 to 0.00, p=0.123. Since the 95% CI lower limit of −4.5 was less than our prespecified margin of −2.0, we failed to conclude non-inferiority of the serratus block with regard to opioid consumption.
Conclusions Serratus blocks provided inferior analgesia compared with paravertebral blocks. Without a dramatic improvement in safety profile for serratus blocks, it appears that paravertebral blocks are superior to serratus blocks for postoperative analgesia after non-mastectomy breast surgery.
Trial registration number NCT03860974.
- regional anesthesia
- nerve block
Data availability statement
Data are available on reasonable request. Data contains PHI and is institutional data. Request for data would have to abide by HIPAA compliance rules.
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Contributors RG, MCD and BMI: this author helped with literature search, data collection, study design, analysis of data, manuscript preparation and review of manuscript; MWS, AA, SB, MD, AS and CR: this author helped with literature search, study design, manuscript preparation and review of manuscript; JFS, BPC, ETS, WBA, BK, BSA, JJF and AMW: this author helped with literature search, data collection, study design, manuscript preparation and review of 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 The University of California has received funding and product for other research projects from Epimed International (Farmers Branch, Texas, USA); Infutronics (Natick, Massachusetts, USA); and SPR Therapeutics (Cleveland, Ohio, USA) for the following authors: RG, MWS, JFS, ETS, BK, JJF, AMW and BMI. RG is a consultant for Avanos (Alpharetta, Georgia, USA).
Provenance and peer review Not commissioned; externally peer reviewed.