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  • Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial

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Original research
Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial
  1. Rodney A Gabriel1,2,
  2. Matthew W Swisher1,
  3. Jacklynn F Sztain1,
  4. Brian P Curran1,
  5. Engy T Said1,
  6. Wendy B Abramson1,
  7. Bahareh Khatibi1,
  8. Brenton S Alexander1,
  9. John J Finneran1,
  10. Anne M Wallace3,
  11. Ava Armani3,
  12. Sarah Blair3,
  13. Marek Dobke3,
  14. Ahmed Suliman3,
  15. Christopher Reid3,
  16. Michael C Donohue4 and
  17. Brian M Ilfeld1
  1. 1Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA
  2. 2Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
  3. 3Department of Surgery, University of California San Diego, La Jolla, California, USA
  4. 4Department of Neurology, University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Rodney A Gabriel, Department of Anesthesiology, University of California San Diego, La Jolla, USA; ragabriel{at}health.ucsd.edu

Abstract

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
  • pain
  • postoperative
  • 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.

https://doi.org/10.1136/rapm-2021-102785

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    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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    Footnotes

    • 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.