Preemptive Analgesic Efficacy of the Ultrasound-Guided Bilateral Superficial Serratus Plane Block on Postoperative Pain in Breast Reduction Surgery: A Prospective Randomized Controlled Study
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Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Preemptive regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. The aim of this study was to evaluate the effect of preoperative bilateral serratus plane block on postoperative opioid consumption in patients undergoing breast reduction surgery.
After ethical board approval, 40 patients undergoing breast reduction surgery were randomized into 2 groups: control group (Group C, n = 20) and serratus plane block group (Group SPB, n = 20). Group C received bilateral ultrasound-guided 2 ml 0.9% saline subcutaneously each block side, Group SPB received ultrasound-guided bilateral SPB with 0.25% bupivacaine 30 ml each side. The groups were administered the routine general anesthesia protocol. All operations were performed with the mediocentral pedicled reduction mammaplasty technique by the same surgeon. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement and opioid-related side effects were recorded during the first 24 h after surgery.
Compared with control, the VAS score was statistically lower in the SPB group during all measurement times (p < 0.05). The 24-h opioid consumption was significantly higher in the control group compared with the SPB group (372.50 ± 39.65 vs. 296.25 ± 58.08 μq, respectively; p < 0.001). In addition, the analgesia requirement was statistically lower in the SPB group (8/20 vs. 2/20, respectively, p < 0.028). Nausea or vomiting was observed more often in the control group than in SPB block (9/20 vs. 2/20, respectively, p = 0.013), whereas other side effects were similar for the two groups.
SPB can be used safely bilaterally in the management of pain for breast reduction surgery as it is easy to perform, provides excellent analgesia, and reduces opioid consumption and opioid sparing effect.
Level of Evidence II
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KeywordsSerratus plane block Breast reduction surgery Pain Preemptive analgesia Ultrasonography
The authors have no sources of funding to declare for this manuscript
Compliance with Ethical Standards
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Institutional Review Board approval was obtained.
Written informed consent was obtained from all subjects (patients) in this study.
- 17.Gago Martinez A, Escontrela Rodriguez B, Planas Roca A, Martinez Ruiz A (2016) Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo-controlled, randomized clinical trial. PLoS ONE 11(5):e0154004. https://doi.org/10.1371/journal.pone.0154004 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Tan P, Martin MS, Shank N, Myers L, Wolfe E, Lindsey J, Metzinger S (2017) A comparison of 4 analgesic regimens for acute postoperative pain control in breast augmentation patients. Ann Plast Surg 78(6S Suppl 5):S299–S304. https://doi.org/10.1097/sap.0000000000001132 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Karaca O, Pinar HU, Arpaci E, Dogan R, Cok OY, Ahiskalioglu A (2019) The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study. Anaesth Crit Care Pain Med 38(1):47–52. https://doi.org/10.1016/j.accpm.2018.03.009 CrossRefPubMedGoogle Scholar
- 24.Ekinci M, Ciftci B, Celik EC, Karakaya MA, Demiraran Y (2019) The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomized, controlled study. Aesthetic Plast Surg 43(2):297–304. https://doi.org/10.1007/s00266-019-01322-8 CrossRefPubMedGoogle Scholar
- 25.Oksuz G, Bilgen F, Arslan M, Duman Y, Urfalioglu A, Bilal B (2019) Ultrasound-guided bilateral erector spinae block versus tumescent anesthesia for postoperative analgesia in patients undergoing reduction mammoplasty: a randomized controlled study. Aesthetic Plast Surg 43(2):291–296. https://doi.org/10.1007/s00266-018-1286-8 CrossRefPubMedGoogle Scholar
- 26.Schuitemaker RJ, Sala-Blanch X, Sanchez Cohen AP, Lopez-Pantaleon LA, Mayoral RJ, Cubero M (2019) Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: a randomised, controlled, triple-blind clinical trial. Rev Esp Anestesiol Reanim 66(2):62–71. https://doi.org/10.1016/j.redar.2018.08.001 CrossRefGoogle Scholar
- 27.Hadzic A (2017) Hadzic’s textbook of regional anesthesia and acute pain management, 2nd edn. McGraw-Hill Education, New YorkGoogle Scholar
- 28.Butterworth JF, Lahaye L (2019) Clinical use of local anesthetics in anesthesia. UpToDate.com. https://www.uptodate.com/contents/clinical-use-of-local-anesthetics-in-anesthesia?csi=92468338-3863-4d6f-860a-eaef407b16d7&source=contentShare. Accessed 19 Apr 2019
- 30.Vandepitte C, Kuroda M, Witvrouw R, Anne L, Bellemans J, Corten K, Vanelderen P, Mesotten D, Leunen I, Heylen M, Van Boxstael S, Golebiewski M, Van de Velde M, Knezevic NN, Hadzic A (2017) Addition of liposome bupivacaine to bupivacaine HCl versus bupivacaine HCl alone for interscalene brachial plexus block in patients having major shoulder surgery. Reg Anesth Pain Med 42(3):334–341. https://doi.org/10.1097/aap.0000000000000560 CrossRefPubMedGoogle Scholar
- 31.Patel MA, Gadsden JC, Nedeljkovic SS, Bao X, Zeballos JL, Yu V, Ayad SS, Bendtsen TF (2019) Brachial plexus block with liposomal bupivacaine for shoulder surgery improves analgesia and reduces opioid consumption: results from a multicenter, randomized, double-blind, controlled trial. Pain Med. https://doi.org/10.1093/pm/pnz103 CrossRefPubMedGoogle Scholar
- 33.Bonomi S, Salval A, Crippa S (2016) Ultrasound-guided thoracic wall nerve blocks to reduce postoperative pain and eliminate opioid consumption in patients undergoing implant-based breast reconstruction. Plast Reconstr Surg 138(3):543e–544e. https://doi.org/10.1097/prs.0000000000002436 CrossRefPubMedGoogle Scholar
- 36.Abdallah FW, MacLean D, Madjdpour C, Cil T, Bhatia A, Brull R (2017) Pectoralis and serratus fascial plane blocks each provide early analgesic benefits following ambulatory breast cancer surgery: a retrospective propensity-matched cohort study. Anesth Analg 125(1):294–302. https://doi.org/10.1213/ane.0000000000001975 CrossRefPubMedGoogle Scholar