A randomized controlled study comparing thoracic paravertebral block to serratus anterior plane block in breast surgery

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Mohamed Hussein Helmy
Mahmoud Salem Soliman
Michael Zarif Sobhy
Ahmed Zaghloul Fouad
Ahmed Abdalla Mohamed
Laila Halim Doss
Ashraf Mohamed Abdelreheem


TPVB, SAPB, breast surgery, VAS, analgesia


Background: Breast surgeries cause severe acute pain and may result in chronic pain in 60% of cases. Thoracic paravertebral block (TPVB) is a reliable analgesic approach. The serratus anterior plane block (SAPB) is a recent block as the local anaesthetic is infiltrated at the fifth rib deep to the serratus anterior muscle (SAM) in the mid axillary line (MAL). This study compared the analgesic duration and efficacy of the SAPB versus that of the TPVB for postoperative pain management after mastectomy.
Patients and methods: This randomized controlled trial included 50 females undergoing breast surgery randomly allocated into two equal groups. Group I: 25 cases received TPVB and Group II: 25 cases received SAPB. Postoperatively, all cases were subjected to evaluation of the time of the first analgesic drug request, visual analogue score (VAS) and total morphine consumption. Heart rate and arterial blood pressure and postoperative nausea and vomiting (PONV) impact scale were recorded.
Results: The time for first analgesic request was significantly longer in the TPVB group than the SAPB group. There was a significant decrease in VAS results after 2 hours in the TPVB group 2 vs 2.72 in the SABP group with significant tachycardia in the intra-operative, immediate postoperative and 2 hours postoperative period. PONV between both groups had no significant difference.
Conclusion: The study favours TPVB regarding analgesic efficacy, delayed requirement for first rescue analgesia, extended analgesic duration and reduced morphine consumption. SAPB, on the other hand, provides a safe, easy application with good analgesic efficacy and fewer side effects.

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