Analgesic efficacy of serratus anterior plane block versus paravertebral block in mastectomy surgery

Objectives To compare the perioperative analgesic efficacy of serratus anterior plan block (SAPB) versus paravertebral block in patients undergoing mastectomy surgery. Background Patients undergoing mastectomy surgery often experience severe postoperative pain. Inadequate control of this pain increases the risk of postoperative complications and may develop into chronic pain. Patients and methods This prospective randomized trial was carried out on 60 female patients, American Society of Anesthesiologists I–III, 30–60 years old, scheduled for modified radical mastectomy, between April 2020 and March 2021. The patients were randomly allocated into one of two groups (30 patients each). Group S received ultrasound-guided SAPB and group P received ultrasound-guided thoracic paravertebral block (TPVB). In both blocks, the injectate was 20-ml bupivacaine 0.25% with epinephrine (5 μg/ml) and fentanyl (2 μg/ml). Both blocks were performed as a single injection after general anesthesia induction. Intraoperative fentanyl consumption, postoperative visual analog scale scores, time-to-first ketorolac request, total postoperative ketorolac consumption, and patients' satisfaction were recorded. Data were analyzed by SPSS, version 26, Mann–Whitney test, Student t test, and variance test. Results Both groups had comparable intraoperative fentanyl consumption (P = 0.15). However TPVB was associated with significantly lower postoperative analgesic requirements, longer time to first analgesic request, and higher grade of patient satisfaction (P < 0.001). Visual analog scale scores were significantly lower in group P at 2, 3, 8, and 17 h (P < 0.001) while being comparable at the remaining time points. Conclusion TPVB and SAPB were associated with comparable intraoperative analgesic efficacy; however, TPVB was associated with a better postoperative analgesic profile and patient satisfaction.