Comparison between ultrasound-guided serratus anterior plane block and thoracic epidural for postoperative analgesia after modified radical mastectomy

Abstract

Background Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high-quality analgesia with minimal side effects. The aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the first 24 h determined by the visual analog scale (VAS) score. The second aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the first 24 h, and patient satisfaction. Patients and methods Forty female patients aged 25–50 years, American Society of Anesthesiologists class II or III scheduled for elective unilateral modified radical mastectomy were studied. Patients were randomly allocated to two groups; group E (epidural group) (n=20) received 20 ml of 0.25% bupivacaine and group S (serratus anterior block group) (n=20) received 20 ml of 0.25% bupivacaine. Results There was no difference between both groups as regards demographic data, heart rate, systolic blood pressure, SpO2, and end-tidal CO2 and associated complications. Moreover, group E had a significant lower VAS score than group S. Group E took longer time to perform the analgesic technique. Group E required significantly less rescue analgesia in the first 24 h. Group S analgesic duration was significantly shorter than in group E. Conclusions Serratus anterior plane block is a good, simple alternative and a safe technique than thoracic epidural analgesia both providing effective intraoperative analgesia and prolonged postoperative pain relief after breast surgery with comparable postoperative VAS score in the first 24 h.