Comparison of Ultrasound-guided Erector spinae plane block and Serratus anterior plane block with Levobupivacaine for intraoperative and post-operative analgesia in Modified radical mastectomy under General Anesthesia

Background: The incidence of Ca. Breast is very high (14% in India)1. One of the most common surgeries is the Modified Radical Mastectomy (MRM). The complicated nerve supply of the breast makes analgesia difficult after MRM. Post-mastectomy pain syndrome is a type of postoperative pain that affects 10–20% of people. 2. Applying local anaesthetic in an interfascial plane that peripheral nerves pass through is the aim of USG-guided interfascial plane blocks, such as the erector spinae plane (ESP) block and the serratus anterior plane (SAP) block. For long-lasting analgesia, regional fascial plane blocks are appropriate. Nausea and vomiting are common side effects of using opioids alone to treat post-mastectomy pain. In 25% to 40% of patients, poor pain management may eventually result in chronic pain syndrome (paraesthesia, phantom breast pain, and intercostobrachial neuralgia). This study aimed to evaluate the analgesic efficacy of USG guided erector spinae plane block and serratus anterior plane block, the necessity of further analgesic dosages within 24 hours following surgery, and any possible adverse effects. Material and Methods: A single blind randomized clinical trial was conducted among 100 patients undergoing MRM surgery under general anaesthesia. Number of study subjects in ESP and SAP block = 50 each. Both groups received USG-guided blocks with levobupivacaine (0.25%) 30 ml. Then all patients were administered conventional method of GA. Results: The time to request of the first rescue analgesia was comparable in group E 24.81(2.96) and in Group S 7.86(1.62) (P < 0.001). Postoperative pain scores were significantly lower in erector spinae plane group as compared serratus anterior plane group (P <0.001) at 6 ,12, 24 hrs. The intraoperative haemodynamic stability was better, postoperative analgesic requirement in Group E 0.40(0.49) and Group S 1.38(1.38) P<0.001 and side effects were less in Group E. Conclusion: ESP block was found to be better as it provides better haemodynamic stability intraoperatively, significantly decreases the post-operative analgesic requirement and has prolonged duration of analgesia as compared to SAP block.

Keywords: Serratus anterior plane block, regional anaesthesia, modified radical mastectomy, and erector spinae plane block.