Serratus Plane Plus Pectoral I Block Versus Serratus Plane Block for Perioperative Analgesia in Breast Cancer Surgery
Condition: Postoperative Pain; Postoperative Nausea; Patient Satisfaction; Narcotic Use
MeSH terms: Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      Breast cancer is the most common malignancy in women at worldwide. Even a minor breast
      surgery can cause significant postoperative pain (PP) (1). PP could be converted into chronic
      pain in 25-40% of cases. Inadequate PP control is associated with increased morbidity, delay
      in wound healing, prolonged hospital stay, increased opioid use, increased side effects and
      high cost of care. For these reasons, regional anesthetic techniques are recommended for
      effective PP management. Some of recent studies suggest that ultrasound-guided pectoral I
      (PI), pectoral II (PII) and serratus plan block (SPB) may be an alternative to thoracic
      epidural analgesia and paravertebral block applications because of the ease of
      administration, low side effect profile and adequate analgesia in breast surgery. (2,3).
    

Detailed description: 
      In breast surgeries, the serratus plane block has recently been described and rapidly became
      popular. The serratus plane block is called the modified pectoral II block. Local anesthetic
      drugs are injected onto the serratus muscle by targeting thoracodorsal nerve, thoracicus
      longus nerve, lateral and anterior branches of the T2-T9 intercostal nerves. In the pectoral
      I (Pecs I) block, the medial and lateral pectoral nerves of the brachial plexus are targeted.
      Additionally, Pecs I block can be effective for analgesia in axillary dissection. In the
      literature, there are studies comparing pectoral I + II blocks and serratus plane block in
      terms of analgesic efficacy in breast surgery. The aim of this study was to evaluate the
      postoperative analgesic efficiency of serratus plane block and serratus plan block plus
      pectoral I block combination.

      Participans will be informed about the potential benefits and complications after the study
      protocol has been fully and thoroughly explained. After premedication with 0.03 mg / kg iv
      midazolam, participans will be noninvasively monitored by taking into the operating room
      (heart rate, blood pressure, pulse oximetry). Anesthesia induction will delivered with
      fentanyl 1mcg / kg, propofol 1.5-2 mg / kg and rocuronium 0.5 mg / kg. The maintenance of
      anesthesia will be achieved by infusion of sevoflurane 1-3% in 50% O2/50% medical air. The
      depth of anesthesia will be evaluated with bispectral index monitoring and will be kept
      between 40 and 60.. Thirty minutes before end of the surgery, all patients were intravenously
      administered 20 mg tenoxicam HCl and 1gr paracetamol.

      SPB plus Pecs I block technique: Bupivacaine/lidocaine mixture will be injected onto the
      serratus muscle and injected between the pectoralis minor/pectoralis major muscles.

      SPB technique: Bupivacaine/lidocaine mixture will be injected onto the serratus muscle.

      After the surgery, 1 g paracetamol was intravenously administered once every 8 h.
      Postoperative pain was assessed using VAS (VAS 0 = no pain, VAS 10 = most severe pain ).
      Morphine 0.1mg / kg will be used as rescue analgesic drug.Duration at PACU was recorded right
      from 0 h. VAS scores at 0, 1,2, 6, 12 and 24 h were recorded. PONV was evaluated using a
      numeric ranking scale (0 = no PONV, 1 = mild nausea, 2 = severe nausea or vomiting once
      attack, and 3 = vomiting more than once attack). If PONV score was >2, the antiemetic
      metoclopramide Hcl 10mg was intravenously administered.
    

Intervention name(s): Serratus Plane Block; Serratus Plane Block plus Pectoral I Block
Intervention type(s): Other; Other
Intervention description(s): 0.5 ml /kg Bupivacaine/lidocaine mixture will be injected onto the serratus muscle; 0.5 ml / kg %0.25 Bupivacaine/ %1 lidocaine mixture will be injected onto the serratus muscle and injected between the pectoralis minor/pectoralis major muscles.2/3 of the total drug will be applied for the serratus plane block and 1/3 of the total drug for the pectoral I block. If the total amount of the drug is less than 30 ml, it will be completed with isotonic saline to 30 ml.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment
Keywords: serratus plane block; pectoral I block; breast cancer surgery; perioperative analgesia