Preemptive Analgesic Efficacy of the Ultrasound-Guided Bilateral Superficial Serratus Plane Block on Postoperative Pain in Breast Reduction Surgery: A Prospective Randomized Controlled Study

• Published in: Aesthetic plastic surgery Vol. 44; no. 1; pp. 37 - 44
• Main Authors: Ahiskalioglu, Ali, Yayik, Ahmet Murat, Demir, Ufuk, Ahiskalioglu, Elif Oral, Celik, Erkan Cem, Ekinci, Mursel, Celik, Mine, Cinal, Hakan, Tan, Onder, Aydin, Muhammed Enes
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2020; Springer Nature B.V
• Subjects: Analgesics; Anesthetics, Local; Breast surgery; Female; Humans; Local anesthesia; Mammaplasty - adverse effects; Mastectomy; Medicine; Medicine & Public Health; Narcotics; Nerve Block; Original Article; Otorhinolaryngology; Pain; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Plastic Surgery; Postoperative period; Prospective Studies; Surgery; Ultrasonic imaging; Ultrasonography, Interventional; Serratus plane block; Breast reduction surgery; Pain; Preemptive analgesia; Ultrasonography
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-019-01542-y

Purpose Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Preemptive regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. The aim of this study was to evaluate the effect of preoperative bilateral serratus plane block on postoperative opioid consumption in patients undergoing breast reduction surgery. Methods After ethical board approval, 40 patients undergoing breast reduction surgery were randomized into 2 groups: control group (Group C, n  = 20) and serratus plane block group (Group SPB, n  = 20). Group C received bilateral ultrasound-guided 2 ml 0.9% saline subcutaneously each block side, Group SPB received ultrasound-guided bilateral SPB with 0.25% bupivacaine 30 ml each side. The groups were administered the routine general anesthesia protocol. All operations were performed with the mediocentral pedicled reduction mammaplasty technique by the same surgeon. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement and opioid-related side effects were recorded during the first 24 h after surgery. Results Compared with control, the VAS score was statistically lower in the SPB group during all measurement times ( p  < 0.05). The 24-h opioid consumption was significantly higher in the control group compared with the SPB group (372.50 ± 39.65 vs. 296.25 ± 58.08 μq, respectively; p  < 0.001). In addition, the analgesia requirement was statistically lower in the SPB group (8/20 vs. 2/20, respectively, p  < 0.028). Nausea or vomiting was observed more often in the control group than in SPB block (9/20 vs. 2/20, respectively, p  = 0.013), whereas other side effects were similar for the two groups. Conclusions SPB can be used safely bilaterally in the management of pain for breast reduction surgery as it is easy to perform, provides excellent analgesia, and reduces opioid consumption and opioid sparing effect. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .