Optimal Injection Site for Serratus Anterior Plane Block in Reconstructive Breast Surgery

Study Overview
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Brief Summary
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The novel introduction of various chest wall blocks such as the Pecs I and II/modified Pecs blocks as well as the Serratus Anterior Plane Block have extended the application of perioperative regional anesthesia to provide analgesia for breast surgery. However, to our knowledge, there are no large studies that truly delineate the optimal injection site for the Serratus Anterior Plane Block.

Detailed Description
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Analgesia for reconstructive breast surgery can be a challenging undertaking; these women have often been through painful mastectomy procedures coupled with the mental and physical discomfort of chemotherapy and its attendant side effects. Additionally, the surgery itself can provoke significant pain; often requiring extensive dissection of soft tissue and muscle to provide flap coverage as well the real discomfort of tissue expansion. The literature has described 2 possible injection sites for the Serratus Anterior Block, however, no study has defined optimal location based on analgesia and duration. Patients will be randomized to receive a deep Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to the serratus or a superficial Serratus Anterior Block (SSAB) where the local anesthetic is placed between serratus and latissimus dorsi. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting.

Official Title
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Optimal Injection Site for Serratus Anterior Plane Block in Reconstructive Breast Surgery (Randomized, Pilot Study)

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Drug: Bupivacaine
* Drug: Dexamethasone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing reconstructive breast surgery Exclusion Criteria: Patients with allergies to the local anesthetic Patients who do no consent to regional anesthesia Patients in which serratus block would be contraindicated Patients whose anatomy preclude placement of the block

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There has been no large, randomized study to define optimal location of injection based on analgesia and duration. Patients will be randomized to receive a deep Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to the serratus or a superficial Serratus Anterior Block (SSAB) where the local anesthetic is placed between serratus and latissimus dorsi.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Deep Serratus Anterior Block<br>Patients in the deep Serratus Anterior Block (DSAB) group will have 20-60cc of 0.25% bupivacaine and 2-4mg of dexamethasone deposited deep to the serratus. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting. | Drug: Bupivacaine<br>* 20-60cc of 0.25% Bupivacaine<br>* Other names: Marcaine, Sensorcaine;Drug: Dexamethasone<br>* 2-4mg of Dexamethasone<br>* Other names: Ozurdex, Decadron, DexPak, Maxidex, Baycadron;|
| Active Comparator: Superficial Serratus Anterior Block<br>Patients in the superficial Serratus Anterior Block (SSAB) group will have 20-60cc of 0.25% bupivacaine and 2-4mg of dexamethasone placed between serratus and latissimus dorsi. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting. | Drug: Bupivacaine<br>* 20-60cc of 0.25% Bupivacaine<br>* Other names: Marcaine, Sensorcaine;Drug: Dexamethasone<br>* 2-4mg of Dexamethasone<br>* Other names: Ozurdex, Decadron, DexPak, Maxidex, Baycadron;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Pain Score | Collection of pain scores (VAS) until approximately 48 hours post-operatively | baseline to 48 hrs postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average Opioid consumption | Average opioid consumption 48hrs postoperatively between study group and control | 48 hrs postoperatively | 
| Length of Stay | Number of days in the hospital | baseline to 72 hrs post-operatively | 
| PONV Medications | Mean time onset use of rescue PONV medications postoperatively | baseline to 48 hrs post-operatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Deep Serratus Block, Reconstructive Breast Surgery, Superficial Serratus block