Effect of erector spinae plane block versus serratus anterior block on post mastectomy pain syndrome (PMPS): a randomized study

Abstract

Background & objective: The most frequent malignancy in women is breast cancer (BC), and besides chemotherapy and radiotherapy, partial or total surgical resection is required. Modified Radical Mastectomy (MRM) is a common surgical intervention for BC management. The procedure needs multimodal analgesia to manage the perioperative pain, which is often severe to intolerable.

This study aimed to compare the effect of ultrasound-guided erector spinae plane block (ESPB) and ultrasound-guided serratus anterior plane block (SAPB) on the incidence of Post Mastectomy Pain Syndrome (PMPS) in patients undergoing MRM under general anesthesia.

Methodology: We enrolled 120 female cancer patients, ASA II or III, and randomized into three groups; ESPB group to receive ESPB, SAPB group to receive SAPB, and a control group. The primary outcome was the incidence of PMPS during 24 weeks postoperatively. Secondary outcomes included acute postoperative pain, opioid consumption, quality of life, and the patient satisfaction.

Results: Out of 120 patients, 37 (30.8%) developed PMPS, with 13 (10%) reporting mild, 14 (11%) moderate, and 10 (8%) reporting severe pain. PMPS was developed by 47.5% (95%CI: 31.5%-63.9%) of individuals in the control group and 30% (95%CI: 16.6%-46.5%) and 15% (95%CI: 5.7%-29.3%) of participants in the SAPB and ESPB groups, respectively (P = 0.007).Compared to the control group, the ESPB group showed a significant reduction in PMPS rate. Meanwhile, there was no significant difference between the SAPB group and the control or ESPB groups. Severe PMPS was more common in the control and SAPB groups compared to the ESPB group. ESPB group provided significantly better analgesic efficacy in the acute phase, lower opioid consumption, lower pain scores, improved quality of life and higher patient satisfaction compared to the SAPB group and the control groups.

Conclusion: ESPB significantly reduced PMPS incidence and severity. SAPB improved acute pain but showed no significant PMPS reduction. ESPB is more effective for PMPS prevention.

Abbreviations: ESPB: serratus anterior plane block, LANSS: Leeds Assessment of Neuropathic Symptoms and Signs, PMPS: Post Mastectomy Pain Syndrome, SAPB: serratus anterior plane block,

Keywords: Block; Cancer; Incidence; Mastectomy; Pain; Serratus Anterior Muscle

Citation: Abed SM, Elsheikh S, Bakeer AH, Magdy M, Abdelfattah ME. Effect of erector spinae plane block versus serratus anterior block on post mastectomy pain syndrome: a randomized study. Anaesth. pain intensive care 2025;29(4):299-308. DOI: 10.35975/apic.v29i5.2853

Received: April 24, 2025; Revised: June 12, 2025; Accepted: June 25, 2025