Optimal Injection Site for Serratus Anterior Plane Block in Reconstructive Breast Surgery

The University of Alabama at Birmingham

Status and phase: Withdrawn; Phase 3

Conditions: Pain, Postoperative

Treatments: Drug: Dexamethasone; Drug: Bupivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT03183596

F000000000

Details and patient eligibility

About

The novel introduction of various chest wall blocks such as the Pecs I and II/modified Pecs blocks as well as the Serratus Anterior Plane Block have extended the application of perioperative regional anesthesia to provide analgesia for breast surgery. However, to our knowledge, there are no large studies that truly delineate the optimal injection site for the Serratus Anterior Plane Block.

Full description

Analgesia for reconstructive breast surgery can be a challenging undertaking; these women have often been through painful mastectomy procedures coupled with the mental and physical discomfort of chemotherapy and its attendant side effects. Additionally, the surgery itself can provoke significant pain; often requiring extensive dissection of soft tissue and muscle to provide flap coverage as well the real discomfort of tissue expansion. The literature has described 2 possible injection sites for the Serratus Anterior Block, however, no study has defined optimal location based on analgesia and duration. Patients will be randomized to receive a "deep" Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to the serratus or a "superficial" Serratus Anterior Block (SSAB) where the local anesthetic is placed between serratus and latissimus dorsi. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting.

Sex: All

Ages: 18 to 100 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients undergoing reconstructive breast surgery

Exclusion criteria

• Patients with allergies to the local anesthetic
• Patients who do no consent to regional anesthesia
• Patients in which serratus block would be contraindicated
• Patients whose anatomy preclude placement of the block

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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0 participants in 2 patient groups

Deep Serratus Anterior Block

Active Comparator group

Description:

Patients in the "deep" Serratus Anterior Block (DSAB) group will have 20-60cc of 0.25% bupivacaine and 2-4mg of dexamethasone deposited deep to the serratus. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting.

Treatment:

Drug: Dexamethasone

Drug: Bupivacaine

Superficial Serratus Anterior Block

Active Comparator group

Description:

Patients in the "superficial" Serratus Anterior Block (SSAB) group will have 20-60cc of 0.25% bupivacaine and 2-4mg of dexamethasone placed between serratus and latissimus dorsi. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting.

Treatment:

Drug: Dexamethasone

Drug: Bupivacaine