Analgesic Efficacy of Ultrasound Guided Serratus Anterior Plane Block and Pectoral Nerve Block II

Azhar University

Status: Enrolling

Conditions: Radical Mastectomy; Anesthesia

Treatments: Procedure: Anethesia

Study type: Interventional

Funder types: Other

Identifiers

NCT06188156

Ahmed Elbasuni Ali

Details and patient eligibility

About

Modified Radical Mastectomy accounts for 31% of all breast surgeries and considered the fundamental surgical management for breast cancer. Nearly 40-60% of patients experience severe acute postoperative pain. This pain might persist for 6-12 months and result in post-mastectomy pain syndrome and complex regional pain syndrome (causalgia)

Full description

There are some local or regional nerve blocks in breast surgeries performed as core components of multimodal analgesia and enhanced recovery after surgery (ERAS), including thoracic epidural (TEB), interscalene brachial plexus, paravertebral, ultrasound-guided pectoral nerve block ( PECS II ), ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block .

Thoracic epidural (TEB) is the gold standard technique following breast surgery, but there is still a problem with the adequacy of thoracic and axillary blockage during lymph node dissection .

Modified PECS's block" or PECS block type II aimed to block the axilla that is vital for axillary clearances and the intercostal nerves, necessary for wide excisions which can provide analgesia after breast surgery.

In the ultrasound-guided serratus anterior plane block (SAPB), the local anesthetic (LA) is injected in the compartment between the serratus anterior and latissimus dorsi muscles. SAPB anesthetizes the intercostobrachial nerve, lateral cutaneous branches of the intercostal nerves (T3-T9), long thoracic nerve, and thoracodorsal nerve thus providing analgesia for breast and lateral thoracic wall surgeries

Enrollment: 99 estimated patients

Sex: Female

Ages: 35 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Women aged 35-65 years.
• BMI 18.5 - 25 kg/m2.
• American Society of Anesthesiologists (ASA) I-II.

Exclusion criteria

• Patient refusal.
• Coagulopathy.
• Mental and psychiatric disorders.
• History of chronic pain.
• Hypersensitivity or contraindication to any of study drugs
• Previous chemotherapy.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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99 participants in 3 patient groups

Thoracic Epidural Block(Group 1)

Active Comparator group

Description:

About 33 Patients will receive thoracic epidural block with an injection of a single shot of 15ml of 0.25% bupivacaine between T4 and T5 vertebrae.

Treatment:

Procedure: Anethesia

Ultrasound Guided Sserratus Anterior Plane Block (Group 2)

Active Comparator group

Description:

About 33 Patients will receive Ultrasound Guided Sserratus Anterior Plane Block( SAPB) with an injection of 30 ml bupivacaine 0.25% .

Treatment:

Procedure: Anethesia

Ultrasound Guided Pectoral Nerve Block (Group 3)

Active Comparator group

Description:

About 33 Patients will receive Ultrasound Guided Pectoral Nerve Block ( PECS II) with an injection of 20 ml bupivacaine 0.25% of pectoral-minor above the Serratus anterior muscle.

Treatment:

Procedure: Anethesia