Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation.
OBJECTIVE
The aim of this study was to evaluate the analgesic efficacy and safety of pectoralis-serratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain.


METHODS
A prospective randomized controlled study.


METHODS
Tertiary center, university hospital.


METHODS
Sixty-four adult women, American Society of Anesthesiologists physical status classes I, II, and III, scheduled for unilateral modified radical mastectomy with axillary evacuation.


METHODS
Patients were randomized to receive either pectoralis-serratus interfascial plane block, PS group (n=32), or thoracic paravertebral block, PV group (n=32).


METHODS
Twenty-four-hour morphine consumption and the time to rescue analgesic were recorded. The pain intensity evaluated by visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24hours postoperatively was also recorded.


RESULTS
The median (interquartile range) postoperative 24-hour morphine consumption was significantly increased in PS group in comparison to PV group (PS vs PV), 20 mg (16-23 mg) vs 12 mg (10-14 mg) (P<.001). The median postoperative time to first analgesic request was significantly shorter in PS group compared to PV group (PS, 6 hours [5-7 hours], vs PV, 11 hours [9-13 hours]) (P<.001). The intensity of pain was low in both groups in VAS 0, 2, and 4hours postoperatively. However, there was significant reduction in VAS in PV group compared to PS group at 8, 16, and 24hours postoperatively.


CONCLUSIONS
Pectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block.
Department of Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Electronic address: diabhetta25@gmail.com.
Diab Fuad
DF
Hetta
Department of Surgical Oncology, South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Electronic address: rezk.khalid@gmail.com.
Khalid Mohammed
KM
Rezk
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001365:Axilla; D005205:Fascia; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008197:Lymph Node Excision / Q000009:adverse effects*; D015411:Mastectomy, Modified Radical / Q000009:adverse effects*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine
Mastectomy pain; Paravertebral; Pectoralis-serratus block