Serratus Anterior Plane (SAP) Block vs SAP Block Combined With Transverus Thoracic Plane (TTP) Block, for Post-mastectomy Pain Control.
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      a comparison shall be conducted between Serratus anterior plane block, on one hand, and
      transversus thoracic plane block combined with Serratus anterior plane block, on the other
      hand for management of post-mastectomy pain. VAS "Visual Analogue Scale" score will be
      compared in both case, and control groups.
    

Detailed description: 
      Breast cancer is one of the most common cancers in women all over the world. In the united
      states, according to the CDC "Center of Disease Control", it's the second most common cancer
      occurring in women. Perioperative pain after breast surgeries remains to be taken lightly due
      to the minimal invasiveness of breast surgeries. However, it is estimated that 25-60% of
      patients undergoing breast cancer related surgeries develop chronic pain. Acute
      post-operative pain remains an important risk factor in developing chronic post-mastectomy
      pain; about 40% of women will have acute post-operative pain, on the other hand, 50% will
      have chronic pain. Different regional anaesthesia techniques have achieved better management
      of post-breast surgery acute pain and subsequently less frequent chronic pain. Add to that,
      effective regional anaesthesia will decrease both the surgical stress response and the
      requirements of general anaesthetics and opioids, which will keep the function of the immune
      system intact. A lot of regional anaesthesia techniques have been used to control anterior
      chest wall pain as the pectoral nerves (PECs) block, paravertebral block, intercostal nerve
      blocks, thoracic epidural analgesia, serratus anterior plane block. The breast receives its
      innervation through the anterior and lateral cutaneous branches of the 2nd to the 6th
      intercostal nerves. Targeting the serratus plane is a safer and a simpler procedure than
      multiple intercostal or paravertebral blocks. As a setback for the serratus anterior plane
      block, it only blocks the lateral cutaneous branches of the intercostal nerves with minimal
      if any effect on the anterior cutaneous branches. The serratus anterior plane block, being
      unable to block the anterior cutaneous branches of the intercostal nerves, have to be
      combined with another technique, transversus thoracic plane block, which can block them. The
      investigators here are trying to measure the efficacy of the combined serratus anterior plane
      block and tranversus thoracic plane block on the management of post-mastectomy pain.
    

Intervention name(s): Serratus anterior plane block; Transversus thoracic plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): •Serratus anterior plane block will be carried out with the patient lying in the lateral position. After skin disinfection, the ultrasound probe will be applied parallel to and between the 5th and 6th ribs in the mid axillary region, for identification of the superficial latissimus dorsi muscles and deep anterior serratus muscles. Then, 25 ml of isobaric bupivacaine 0.25% will be injected above the serratus anterior muscle.; •Transversus thoracic plane block will be carried out with the patient lying in the supine position. After skin disinfection, the ultrasound probe will be applied parallel to and between the 4th and 5th ribs connecting at the sternum. Then, 15 ml of isobaric bupivacaine 0.25% will be injected between the transversus thoracic muscle and the internal intercosatal muscle.
Other intervention name(s): SAP block; TTP block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: serratus anterior plane block; transversus thoracic plane block; post-mastectomy pain