Comparison of Postoperative Analgesic Efficacy of Two Different Blocks in Modified Radical Mastectomy Surgery

Postoperative pain following modified radical mastectomy remains a significant clinical challenge and may delay recovery, impair patient comfort, and increase opioid consumption. Ultrasound-guided fascial plane blocks have become an important component of multimodal analgesia for breast surgery. The serratus anterior plane block (SAPB) is an established regional anesthesia technique that provides effective postoperative analgesia. The serratus posterior superior intercostal plane block (SPSIPB) is a recently described interfascial block with promising analgesic effects, but evidence comparing its efficacy with SAPB in breast surgery remains limited. This prospective, randomized, double-blind, single-center clinical trial aims to compare the postoperative analgesic efficacy of ultrasound-guided SPSIPB and SAPB in patients undergoing modified radical mastectomy under general anesthesia. Seventy female patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status I-III will be randomly assigned to receive either SPSIPB or SAPB before surgery. The primary outcome is postoperative pain intensity assessed using the Visual Analog Scale (VAS). Secondary outcomes include intraoperative remifentanil consumption, cumulative tramadol consumption during the first 24 postoperative hours, postoperative nausea and vomiting (PONV), quality of recovery assessed with the QoR-40 questionnaire, rescue analgesic requirements, and block-related complications. The findings of this study are expected to provide evidence regarding the comparative effectiveness and safety of these two interfascial plane blocks for postoperative analgesia in breast cancer surgery.

Sex

Female

Minimum age

18 Years

Maximum age

65 Years

Inclusion Criteria:

* Female patients aged 18 to 65 years.
* Scheduled for elective modified radical mastectomy under general anesthesia.
* American Society of Anesthesiologists (ASA) physical status I-III.
* Body mass index (BMI) \<35 kg/m².
* Normal coagulation profile (including INR and platelet count).
* Normal liver and renal function tests.
* Able to understand the study procedures and provide written informed consent.

Exclusion Criteria:

* Known allergy or hypersensitivity to local anesthetics.
* Coagulation disorders or bleeding diathesis.
* Infection or inflammation at the planned block site.
* ASA physical status IV or higher.
* Chronic opioid use or chronic pain requiring long-term analgesic therapy.
* Advanced hepatic or renal insufficiency.
* Severe pulmonary disease.
* Opioid use within 24 hours before surgery.
* Cognitive impairment or inability to complete postoperative assessments.
* Revision breast surgery.
* Refusal to participate in the study.

• BACKGROUNDTang W, Luo G, Lu Y, Chen C, Liu H, Li Y. Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial. J Clin Anesth. 2021 Nov;74:110377. doi: 10.1016/j.jclinane.2021.110377. Epub 2021 Jun 9. PMID 34118568
• BACKGROUNDMeng J, Zhao HY, Zhuo XJ, Shen QH. Postoperative Analgesic Effects of Serratus Anterior Plane Block for Thoracic and Breast Surgery: A Meta-analysis of Randomized Controlled Trials. Pain Physician. 2023 Mar;26(2):E51-E62. PMID 36988359
• BACKGROUNDCiftci B, Alver S, Ahiskalioglu A, Bilal B, Tulgar S. Serratus posterior superior intercostal plane block for breast surgery: a report of three cases, novel block and new indication. Minerva Anestesiol. 2023 Nov;89(11):1054-1056. doi: 10.23736/S0375-9393.23.17432-3. Epub 2023 Jun 1. No abstract available. PMID 37272274