Erector Spina Plane Block Versus Deep Serratus Anterior Plane Block for Post Mastectomy Analgesia
Condition: MASTECTOMY
Study type: Interventional

Summary: 
      Breast cancer surgery like Mastectomy and modified radical mastectomy are associated with
      significant postoperative pain, and management depends largely on patient controlled
      analgesia with intravenous Morphine or other opioids equivalents. Respiratory depression,
      Ileus, sedation, nausea and vomiting are some of the potential side effect of opioid
      treatment which prolonged hospital length of stay and increase the coast. Recent advance in
      ultrasound guided regional anesthesia has led to the development of two novel regional
      anesthesia techniques specific to chest wall analgesia; Erector spina plain block and
      Serratus anterior plain block, with its potential to reduce or eliminate the need for opioids
      to manage post-operative pain.
    

Detailed description: 
      Experimental: erector spinae plain block After giving general anesthesia, patient is
      positioned in lateral decubitus with the surgical side up, and prepping para-spinous area
      with antiseptic solution. Ultrasound high frequency linear transducer is positioned in a
      para-sagittal plane at the level of fifth thoracic vertebra. Scanning of interested
      structures from superficial to deep planes, Trapezius muscle, Rhomboid major muscle, Erector
      spina muscle and transverse process of fifth thoracic vertebra.

      Comparator: serratus anterior plane block After giving general anesthesia, patient is
      positioned in lateral decubitus, with the surgical side up. The upper arm is abducted and
      elevated above the head level. Under sterile aseptic technique, a linear ultrasound
      transducer (6-15 MHz) is placed in a sagittal oblique plane over the fourth and fifth ribs at
      the mid-axillary line. The following muscles are identified overlying the fourth/ fifth rib:
      the latissimus dorsi (superficial) and serratus anterior muscle (deep) overlying the ribs.
    

Intervention name(s): Erector spina plain block for mastectomy analgesia; Deep serratus anterior plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): After giving general anesthesia, patient is positioned in lateral decubitus with the surgical side up, An erector Spina plain block is performed with inserting block needle (Pajunk, Geisingen, Germany) in-plane under ultrasound control until needle tip hits the transverse process, a volume of 0.3 ml/kg of bupivacaine 0.25% (Marcaine, Astra Zeneca Pharmaceuticals) is injected. Pain management assessment and analgesic consumption will be provided through patient-controlled analgesia (PCA) for 24 hours. The PCA pump is programmed to deliver 1 mg morphine bolus per press with a lockout interval of 10 min. Pain scores will be measured using eleven points numerical rating scale NRS (0 to 10) and opioids consumption will be documented at 0, 1, 4, 8 and 24 hours. Time of admission to post-anesthesia care unit PACU is considered 0 hours. Any opioid equivalents given during the first 24 hours to manage breakthrough pain will be documented; After giving general anesthesia, the patient is positioned in lateral decubitus, with the surgical side up. The upper arm is abducted and elevated above the head level. A block needle is introduced in-plane, targeting the plane deep to the serratus anterior muscle, and a bolus of 0.3 ml/kg bupivacaine 0.25% is injected through ultrasound guidance. Pain management assessment and analgesic consumption will be provided through patient-controlled analgesia PCA for 24 hours. The PCA pump is programmed to deliver 1 mg morphine bolus per press with a lockout interval of 10 min. Pain scores will be measured using eleven points numerical rating scale NRS (0 to 10), and opioids consumption will be documented at 0, 1, 4, 8 and 24 hours. Time of admission to PACU is considered 0 hours. Any opioid equivalents given during the first 24 hours to manage breakthrough pain will be documented
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment