Preemptive Erector Spinae Plane Block Versus Serratus Anterior Plane Block in MRM

Benha University

Status: Completed

Conditions: Modified Radical Mastectomy

Treatments: Procedure: Erector spinae plane group; Procedure: Serratus anterior plane group

Study type: Interventional

Funder types: Other

Identifiers

NCT06404918

RC 23-11-2023

Details and patient eligibility

About

Modified radical mastectomy (MRM) is one of the most performed surgeries for breast cancer. MRM is associated with significant pain during the immediate postoperative period.

Full description

Modified radical mastectomy (MRM) is one of the most performed surgeries for breast cancer. MRM is associated with significant pain during the immediate postoperative period.

Inadequate pain management has both psychological and physiological repercussions.

Various local or regional nerve blocks like thoracic epidural, interscalene brachial plexus, paravertebral, pectoral nerve blocks, and erector spinae plane blocks are performed in MRM to provide analgesia.

Ultrasound-guided Erector spinae plane block (USG-ESPB) is one of the novel and effective regional techniques where local anaesthetic is deposited deep into the erector spinae muscle, blocking the ventral and dorsal rami of multiple spinal nerves, and is technically simple, with fewer hemodynamic side effects and with minimal complications

Enrollment: 70 patients

Sex: Female

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• female patients
• aged from 18 to 70 years
• with a body mass index ≤ 30 kg/ m2
• American Society of Anesthesiologists (ASA) physical status I-II,
• who were scheduled for MRM for breast cancer

Exclusion criteria

• history of drug allergy,
• psychiatric illness, substance abuse,
• severe cardiovascular or respiratory disease,
• any pre-existing liver disease, metabolic or neurological syndrome, c

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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70 participants in 2 patient groups

Erector spinae plane group

Experimental group

Description:

The patients were placed in lateral decubitus position with the operation site up. The probe was placed vertically 3 cm lateral to the T5 spinous process, and the transverse process was identified as an oval hyperechoic sonographic structure. The needle was introduced in an in-plane fashion until the tip lay deep in the erector spinae muscle. 0.5 mL of normal saline was injected to confirm the correct needle tip position by visualizing the spread under the erector spinae muscle. A total of 0.4 mL kg-1 of 0.25% bupivacaine was injected. between the erector spinae muscle and transverse process.

Treatment:

Procedure: Erector spinae plane group

Serratus anterior plane group

Experimental group

Description:

Serratus anterior plane block was administered to patient in the supine position with ipsilateral arm abducted to 90°. Under aseptic precautions, linear probe was placed over the midclavicular region in the sagittal plane. Ribs were counted inferiorly and laterally until the fifth rib was identified in midaxillary line. Latissimus dorsi, teres major, and serratus anterior muscles were identified overlying the fifth rib. The intended puncture site was infiltrated with 2 mL of 2% lignocaine, and using ultrasound-guided in-plane approach, the needle was introduced in caudal to cranial direction until the tip was placed between the serratus anterior muscle and external intercostal muscle.

Treatment:

Procedure: Serratus anterior plane group