Serratus Plane Versus Paravertebral Nerve Blocks for Breast Surgery
Condition: Breast Surgery
Intervention: Serratus Plane block (single injection); Paravertebral block (single injection)
Intervention description: A single-injection serratus plane block will be administered using ropivacaine 0.5% with epinephrine 1:200,000-400,000 (20 mL of local anesthetic for unilateral surgery; 16 mL of local anesthetic each side for bilateral surgery).; Single injection paravertebral blocks will be administered using ropivacaine 0.5% with epinephrine 1:200,000-400,000 (20 mL for unilateral surgery; 16 mL each side for bilateral surgery). For paravertebral blocks without axillary involvement, this will be at the T3 and T5 levels. For paravertebral blocks with axillary involvement, this will be at the T2 and T4 levels. For unilateral PVBs, 10 mL of local anesthetic will be injected per level. For bilateral paravertebral blocks, 8 mL of local anesthetic will be injected per level.
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 100.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: regional anesthesia; paravertebral; erector spinae; nerve block

Summary:

      Following painful surgical procedures of the breast, postoperative analgesia is often
      provided with a paravertebral nerve block (PVB). For intense, but shorter-duration acute
      pain, a single-injection of local anesthetic is used with a duration of approximately 12
      hours. Recently an alternative block has been reported: the serratus plane block.2 The
      theoretical benefits include ease of administration since it is a plane superficial to the
      PVB and therefore easier to identify and target with ultrasound (therefore increasing success
      rate); and an increased safety margin as there are fewer anatomic structures in the immediate
      area which could be injured with the needle; and, the target plane is much further from the
      intrathecal/epidural space relative to the PVB, therefore leakage of cerebrospinal fluid or
      injury to the spinal cord are less likely with the serratus compared to the PVB.3 There are,
      therefore, multiple theoretical reasons to prefer the serratus over the PVB. Unfortunately,
      it remains unknown if the analgesia provided by this new technique is comparable to that
      provided with the PVB.4 The investigators therefore propose to compare these two techniques
      with a randomized, subject-masked, active-controlled, parallel-arm clinical trial.
    

Eligibility criteria:

        Inclusion Criteria:

          -  undergoing unilateral or bilateral breast surgery with at least moderate postoperative
             pain anticipated

          -  analgesic plan includes a single-injection peripheral nerve block(s)

          -  age 18 years or older

        Exclusion Criteria:

          -  morbid obesity as defined by a body mass index > 40 (BMI=weight in kg / [height in
             meters]2)

          -  renal insufficiency (preoperative creatinine > 1.5 mg/dL)

          -  chronic opioid use (daily use within the 2 weeks prior to surgery and duration of use
             > 4 weeks)

          -  history of opioid abuse

          -  any comorbidity which results in moderate or severe functional limitation inability to
             communicate with the investigators or hospital staff

          -  pregnancy

          -  planned regional analgesic with perineural catheter placement

          -  incarceration