Erector Spina Plane Block Versus Deep Serratus Anterior Plane Block for Post Mastectomy Analgesia

King Saud University

Status: Completed

Conditions: MASTECTOMY

Treatments: Procedure: Deep serratus anterior plane block; Procedure: Erector spina plain block for mastectomy analgesia

Study type: Interventional

Funder types: Other

Identifiers

NCT04108715

E-19-3943

Details and patient eligibility

About

Breast cancer surgery like Mastectomy and modified radical mastectomy are associated with significant postoperative pain, and management depends largely on patient controlled analgesia with intravenous Morphine or other opioids equivalents. Respiratory depression, Ileus, sedation, nausea and vomiting are some of the potential side effect of opioid treatment which prolonged hospital length of stay and increase the coast. Recent advance in ultrasound guided regional anesthesia has led to the development of two novel regional anesthesia techniques specific to chest wall analgesia; Erector spina plain block and Serratus anterior plain block, with its potential to reduce or eliminate the need for opioids to manage post-operative pain.

Full description

Experimental: erector spinae plain block After giving general anesthesia, patient is positioned in lateral decubitus with the surgical side up, and prepping para-spinous area with antiseptic solution. Ultrasound high frequency linear transducer is positioned in a para-sagittal plane at the level of fifth thoracic vertebra. Scanning of interested structures from superficial to deep planes, Trapezius muscle, Rhomboid major muscle, Erector spina muscle and transverse process of fifth thoracic vertebra.

Comparator: serratus anterior plane block After giving general anesthesia, patient is positioned in lateral decubitus, with the surgical side up. The upper arm is abducted and elevated above the head level. Under sterile aseptic technique, a linear ultrasound transducer (6-15 MHz) is placed in a sagittal oblique plane over the fourth and fifth ribs at the mid-axillary line. The following muscles are identified overlying the fourth/ fifth rib: the latissimus dorsi (superficial) and serratus anterior muscle (deep) overlying the ribs.

Enrollment: 80 patients

Sex: Female

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA I-III patients age 18 to 75 years undergoing unilateral breast surgery

Exclusion criteria

• Patients refusal
• History of amide local anesthetics allergy
• Alcohol or drug abuse
• Chronic opioid intake
• Language barriers
• Patient with psychiatric disorders
• Contraindications for regional anesthesia
• BMI > 40 Kg/m2
• Obstructive sleep apnea that preclude PCA opioids

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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80 participants in 2 patient groups

ESPB GROUP

Active Comparator group

Description:

Erector spina plane block group

Treatment:

Procedure: Erector spina plain block for mastectomy analgesia

SAPB group

Active Comparator group

Description:

Deep Serratus anterior plane block group

Treatment:

Procedure: Deep serratus anterior plane block