The effect of serratus plane block performed under direct vision on postoperative pain in breast surgery

Marcus Hards, Arisa Harada, Isobel Neville, Sheelagh Harwell, Mahwash Babar, Abdulsatar Ravalia, Giles Davies
Journal of Clinical Anesthesia 2016, 34: 427-31

STUDY OBJECTIVES: To determine the effectiveness of serratus plane block performed under direct vision on postoperative pain after mastectomy.

DESIGN: We performed a retrospective study of elective breast surgery patients undergoing mastectomy over 6 months. We collected data on the outcomes for the pain score and use of analgesia in recovery, the use of analgesia and antiemetics overnight, and the pain score and mobilization status of the patient 1 day after the operation.

SETTING: Breast cancer is the most common cancer in women, and mastectomy is commonly performed as part of the management. A mastectomy can cause significant acute pain which progresses to chronic pain in 25% to 60% of women. Recent studies have suggested that a serratus plane block is a viable alternative to regional anesthetic techniques without the side effect profile and that injection of local anesthetic into serratus anterior provided predictable and effective anesthesia to the chest wall. Serratus blocks target the thoracic nerves more selectively than pectoral blocks, and local blocks can reduce the use of opiates postoperatively thereby lessening opiate-related side effects.

PATIENTS: Our sample included 16 patients who had received a serratus block and 11 patients who only had wound infiltration with levobupivacaine with adrenaline and clonidine.

INTERVENTION: Serratus plane block was conducted by injecting 50% of the totally available levobupivacaine 0.375% with adrenaline and clonidine deep to serratus anterior under direct observation.

MAIN RESULTS: No patients receiving a serratus block suffered severe pain in recovery or day 1 postoperatively. Patients receiving wound infiltration alone had 2 patients suffering severe pain in recovery and 3 patients suffering severe pain day 1 postoperatively.

CONCLUSION: Serratus block provides effective regional anesthesia, suitable for mastectomies, and currently appears to be superior to wound infiltration alone. However, further data will need to be collected to support this finding.

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