title: "A Tale of Two Planes": Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome.
abstract: BACKGROUND
  Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS.
  
  
  METHODS
  Four patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients' outcomes was obtained through postprocedure interviews.
  
  
  RESULTS
  Three of the patients previously had a superficial serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB.
  
  
  CONCLUSIONS
  We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.
authors.affiliation: From the *Department of Anesthesiology, Weill Medical College of Cornell University and New York Presbyterian Hospital; and †Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Piracha
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Thorp
authors.forename: Vinay
authors.initials: V
authors.lastname: Puttanniah
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gulati
mesh_terms: D000368:Aged; D064131:Back Muscles / Q000000981:diagnostic imaging / Q000294:innervation*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional