Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Epidural Analgesia in Breast Surgery

Abstract

Background: Breast Surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To assess the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for breast surgery. Patients and methods: This is a prospective randomized clinical study done at Aswan University Hospitals. The present study was conducted on sixty female patients ASA I-II, their ages ranged from 20-50 years and scheduled for unilateral breast surgery. The patients were allocated randomly into three groups (n=20 each) according to type of regional anesthesia administrated. Results: There was no significant difference between the studied groups in age, body weight, height and BMI. VAS pain scores throughout the first 24 hrs postoperative showed that there was highly statistically significant decrease in VAS in immediate till 6 hrs postoperative in SAPB group (VAS in group C was less than in groups A and B, P-value < 0.001). As regard to side effects, no complications in the studied groups were recorded such as pneumothorax, vascular puncture, or local anesthetic toxicity. Conclusion: Serratus anterior plane block maintained hemodynamic stability as compared to TE and it produced low pain scores and less total morphine consumption in the early postoperative period after unilateral breast cancer surgery. These advantages, suggest the usefulness of SAPB especially in outpatient surgery.

Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis

“…All included studies report 24-h postoperative VAS [ 10 , 11 , 12 , 17 , 19 , 20 ]. There was significant heterogeneity among the trials ( χ 2 = 361.54, P < 0.00001, I 2 = 99%).…”

“…Five studies reported the VAS score on 12 h postoperative [ 11 , 12 , 17 , 19 , 20 ]. Heterogeneity was found in the pooled results of the trials ( χ 2 = 170.56, P < 0.00001, I 2 = 98%) and significantly no difference in pain on 12 h postoperative in both the groups (MD = -0.06, Z = 0.15, P = 0.88) [ Figure 4b ].…”

“…Additionally, we perform subgroup analysis to compare SSPB versus TEA and DSPB versus TEA. Five studies reported the VAS score on SSPB versus TEA [ 11 , 12 , 17 , 19 , 20 ]. Heterogeneity was found in the pooled results of the trials ( χ 2 = 315.69, P < 0.00001, I 2 = 99%) and significantly no difference in pain in both the groups (MD = 0.46, Z = 1.09, P = 0.27).…”

“…VAS was compared between SAPB and TEA with local anesthetic performed before and after the incision. Four studies reported the VAS score on loading dose before incision [ 10 , 12 , 17 , 20 ]. Heterogeneity was found in the pooled results of the trials ( χ 2 = 308.39, P < 0.00001, I 2 = 99%) and significantly no difference in pain in both the groups (MD = 1.06, Z = 1.23, P = 0.22).…”

“…However, both of these studies did not compare SAPB with recommended analgesic for thoracic surgery, TEA. The occurrence of PONV in two studies suggests a lower incidence in SAPB compared to TEA [ 17 , 18 ], while other studies reported an equal [ 10 ] or a higher incidence of PONV in SAPB [ 11 , 12 , 19 ].…”