Perioperative Analgesic Modalities for Breast Cancer Surgeries

Study Overview
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Brief Summary
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The incidence of breast cancer is among women world wide, detection increased with introduction of mammography as a screening tool. surgical resection of breast cancer contributes to the generation of acute and chronic post mastectomy pain. This study aims at comparing the effect of erector spinae block versus serratus block versus intravenous morphine in patients undergoing modified radical mastectomy for breast cancer surgeries regarding pain control and possible side effects

Detailed Description
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One of the most common types of cancer affecting women is breast cancer. Surgical resection is one of the main approaches applied for solid tumors. surgical approach for breast cancer involve the breast region. Various analgesic modalities are used for proper perioperative pain control. Morphine has always been considered as the gold standard analgesic, however opioids have multiple side effects. Several loco-regional techniques have been introduced for breast surgery pain management including serratus plane block (SPB) and erector spinae plane (ESP) block. In this study the investigators are comparing the effect of erector spinae block versus serratus block versus intravenous morphine in patients undergoing modified radical mastectomy for breast cancer surgeries regarding intraoperative and postoperative analgesia, time to first analgesic, any possible side effects

Official Title
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Perioperative Analgesic Modalities for Breast Cancer Surgeries

Conditions
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Analgesia

Intervention / Treatment
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* Procedure: serratus plane block
* Procedure: erector spinae block
* Drug: Morphine Sulfate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: female 18-65 years old patients undergoing modified radical mastectomy Exclusion Criteria: patient refusal, local infection at site of block coagulation defect abnormal kidney or liver functions

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: erector spinae block<br>Ultrasound guided erector spinae block with will be done after induction of intravenous anesthesia. After identification of trapezius, rhomboid major, and erector spinae muscles. The needle will be inserted in a cephalad-to-caudal direction until the tip contact transverse process and the needle tip is visualized in the plane deep to the erector spinae muscle. The needle tip position is confirmed by visualizing linear spread of test dose between the muscles after injection. A total dose of 25 mL of 0.25% bupivacaine will be injected. | Procedure: erector spinae block<br>* ultrasound guided block<br>* Other names: ESPB;|
| Experimental: serratus anterior block<br>Ultrasound guided serratus anterior block will be done after induction of intravenous anesthesia. The serratus anterior, latissimus dorsi, and the intercostal muscles will be identified in the fourth and fifth intercostal level, an 18 G Tuohy needle will be advanced in the plane between the serratus anterior muscle and the intercostal muscles. A total dose of bupivacaine 25ml in a concentration of 0.25% will be administered under the serratus muscle after a test dose using an in-plane technique. | Procedure: serratus plane block<br>* ultrasound guided block<br>* Other names: SAPB;|
| Active Comparator: intravenous morphine<br>intravenous morphine will be administrated in a dose of 0.1 mg per kg after induction of general anesthesia | Drug: Morphine Sulfate<br>* intravenous morphine sulfate 0.1 mg/kg<br>* Other names: opioid;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue score | minimum score (0), maximum score (10) maximum score (10) | 24 hours | 
| Total morphine consumption | total morphine in mg received in first 24 hours postoprative | 24 hours | 
| First time to receive morphine | first time to receive morphine in the postoperative period (first 24 hours) | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean arterial blood pressure | hemodynamic parameters | 24 hours | 
| heart rate | hemodynamic parameters | 24 hours |