Serratus anterior plane block for postoperative analgesia in modified radical mastectomy

Abstract

Introduction: Serratus Anterior Plane (SAP) block can be used as part of multimodal analgesia, reducing the need for additional analgesia for 24 h postoperatively. The SAP block (SAPB) is easy to apply with a safe technique and low side effects. This study analyzes serratus anterior plane block as postoperative analgesia in Modified Radical Mastectomy (MRM) surgery by assessing the level of pain, side effects, and complications.

Methods: This study was a double-blind randomized control trial (RCT) conducted on patients scheduled to undergo MRM, at Dr. Kariadi Hospital Semarang during August-October 2022. A total of 44 patients were enrolled, and divided into two groups; 22 patients in each group. The treatment group received SAPB and was compared with the control group of morphine 0.1 mg/kg, in terms of the numeric pain rating scale, at 4, 8, 12, and 24 h postoperatively, time and number of analgesic rescue doses, the incidence of PONV and pruritus within 24 h postoperatively. Independent T-test, Mann-Whitney, Chi-square, and Fischer tests were performed to analyze the data. P < 0.05 was considered significant.

Results: The mean NRS at 4, 12, and 24 h postoperatively was lower in the SAPB group than in the control group (2.73 ± 0.77 vs. 3.23 ± 0.53; 1.77 ± 0.61 vs. 2.32 ± 0.48, and 1.45 ± 0.59 vs. 2.09 ± 0.61). The difference was statistically significant, e.g., P = 0.017, P = 0.003, and P = 0.001, respectively. Time to the first request of rescue analgesia was prolonged in the SAPB group than in the control group (398.86 ± 140.6 vs. 100.91 ± 10.3; P = 0.000). The mean rescue analgesic dose in the SAPB group was lower than in the control group (3.59 ± 1.56 vs. 8.55 ± 2.4; P = 0.000). The control group showed a higher incidence of PONV (68.2% vs. 18.2%, P = 0.01). There was no significant difference in the groups regarding the frequency of pruritus (P = 0.073).

Conclusion: Serratus anterior plane block reduced pain significantly up to 24 h postoperatively compared to the control group. The patients in this group needed rescue analgesia after longer duration and needed lower doses of rescue analgesia. There was lower frequency of PONV than the control group.

Abbreviations: MRM - Modified Radical Mastectomy; PONV – Postoperative Nausea and Vomiting; PMPS - Post-Mastectomy Pain Syndrome; PVB – Para Vertebral Block; SAP - Serratus Anterior Plane; VAS - Visual Analog Scale

Key words: Serratus Anterior Plane Block; Breast Cancer; Modified Radical Mastectomy

Citation: Mochamat, Arifin J, Pramadika T, ManapaCH, Istanto W, Wicaksono SA, Nugroho TE. Serratus anterior plane block for postoperative analgesia in modified radical mastectomy. Anaesth. pain intensive care 2023;27(5):486−490; DOI: 10.35975/apic.v27i5.2297

Received: January 05, 2023; Reviewed: January 18, 2023; Accepted: March 31, 2023