Clinical trial · Interventional
Ultrasound-Guided SPSIP Versus ESPB for Postoperative Pain After Modified Radical Mastectomy
Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block Versus Erector Spinae Plane Block for Postoperative Pain Management After Modified Radical Mastectomy: A Randomized Clinical Trial
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
Breast cancer is the most common cancer affecting women worldwide. Modified radical mastectomy is one of the main surgical treatments for breast cancer. However, this surgery is often associated with significant postoperative pain, which may delay recovery and increase the need for opioid medications such as morphine. Regional anesthesia techniques are increasingly used to improve pain control after breast surgery and reduce opioid consumption. The erector spinae plane block (ESPB) is a well-established ultrasound-guided technique that provides effective chest wall analgesia. The serratus posterior superior intercostal plane (SPSIP) block is a newer ultrasound-guided technique that targets intercostal nerves and may provide effective postoperative pain relief. The purpose of this randomized clinical trial is to compare the effectiveness of SPSIP block versus ESPB block in controlling pain after modified radical mastectomy. The primary outcome will be total morphine consumption during the first 24 hours after surgery. Secondary outcomes include pain scores, time to first request for rescue analgesia, hemodynamic stability, recovery profile, patient satisfaction, and postoperative side effects such as nausea and vomiting. This study aims to determine whether the newer SPSIP block provides comparable or superior pain control to ESPB, with the goal of improving postoperative recovery and reducing opioid requirements in breast cancer patients.
Conditions
Conditions (3)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Acute Post-surgical Pain | — | UNRESOLVED | — |
| Breast Cancer | Malignant Breast Neoplasm | CURATED_EXACT | 0.92 |
| Postoperative Pain | — | UNRESOLVED | — |
Interventions
Interventions (2)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| Erector Spinae Plane Block | Procedure | — | UNRESOLVED |
| Serratus Posterior Superior Intercostal Plane Block | Procedure | — | UNRESOLVED |
Design
Arms and outcomes
Arms (2)
- type
- EXPERIMENTAL
- label
- SPSIP Block Group
- description
- Participants will receive an ultrasound-guided serratus posterior superior intercostal plane (SPSIP) block before induction of general anesthesia. A total of 20 mL of 0.25% bupivacaine will be injected into the fascial plane between the serratus posterior superior muscle and the intercostal muscles at the level of the second or third rib. All participants will receive standardized general anesthesia and multimodal postoperative analgesia.
- interventionNames
- Procedure: Serratus Posterior Superior Intercostal Plane Block
- type
- EXPERIMENTAL
- label
- ESPB Block Group
- description
- Participants will receive an ultrasound-guided erector spinae plane block (ESPB) before induction of general anesthesia. A total of 20 mL of 0.25% bupivacaine will be injected deep to the erector spinae muscle at the T4-T5 transverse process level. All participants will receive standardized general anesthesia and multimodal postoperative analgesia.
- interventionNames
- Procedure: Erector Spinae Plane Block
Eligibility
Eligibility (as posted)
- Sex
- Female
- Minimum age
- 18 Years
- Maximum age
- 65 Years
Show eligibility criteria text
Inclusion Criteria: Female patients diagnosed with breast cancer Scheduled for modified radical mastectomy (MRM) American Society of Anesthesiologists (ASA) physical status II or III Age 18-65 years Body mass index (BMI) \> 20 kg/m² and \< 35 kg/m² Ability to understand the study protocol and provide written informed consent Exclusion Criteria: Patient refusal to participate ASA physical status IV or higher BMI ≤ 20 kg/m² or ≥ 35 kg/m² Known hypersensitivity or contraindication to local anesthetics, opioids, or study medications History of chronic pain or regular opioid use Significant psychiatric disorders affecting pain assessment Contraindications to regional anesthesia (e.g., infection at injection site, coagulopathy, pre-existing peripheral neuropathy) Severe respiratory, cardiac, hepatic, or renal disease
References
Publications (2)
- RESULTTulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Korkmaz AO, Bozkurt NN, De Cassai A, Torres AJ, Elsharkawy H, Alici HA. Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain. Cureus. 2023 Feb 3;15(2):e34582. doi: 10.7759/cureus.34582. eCollection 2023 Feb. PMID 36883093
- RESULTBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492. Epub 2018 Sep 12. PMID 30207593