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Mensah DK, deGraft-Johnson PKG, Darkwa EO, Akowuah A, Danso OS, Aryee G, Essuman R, Djagbletey R. Perioperative Analgesic Effect of Serratus Anterior Plane Block for Breast Surgery: A Randomized Control Study at a Large Teaching Hospital in Ghana. Cureus 2024; 16:e63397. [PMID: 39070453 PMCID: PMC11283854 DOI: 10.7759/cureus.63397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Pain after breast surgery has been described as moderate to severe in intensity and, if inadequately treated, increases postoperative morbidity, hospital cost, and the incidence of persistent postoperative pain. Serratus anterior plane (SAP) block is an interfascial injection technique for analgesia of the chest wall. There is a lack of data with regard to its analgesic and possible opioid-sparing effects in Sub-Saharan Africa. This study aimed to determine the perioperative analgesic effect of serratus anterior plane block administered for breast surgery. Methods This was a prospective, randomized, double-blinded study involving 52 patients and was randomized into the intervention (n = 26) and control (n = 26) groups. One patient in the control group did not receive the allocated intervention, while one in the intervention group lost to follow-up. Complete data of 50 participants, comprising intervention (n=25), was used in the analysis. Patients' demographic and health characteristics, pre-induction, intra-operative, and postoperative hemodynamic parameters were noted. After induction of anesthesia, a blinded anesthetist performed an ultrasound-guided serratus anterior plane block with 0.25% plain bupivacaine or a sham block using 0.9% normal saline (control). Numerical rating scale (NRS) score and incidence of postoperative nausea and vomiting (PONV) were recorded immediately after surgery and at 1, 4, 8, and 24 postoperative hours. Patient satisfaction with analgesic management within the first 24 postoperative hours was also assessed. Results Patients who received SAP block had lower NRS scores at all measured time points, but this was only statistically significant at the fourth postoperative hour (p-value = 0.002). Compared to controls, patients who received SAP had lower intraoperative (11.3±1.5 mg vs. 11.9±1.5 mg, p value = 0.131) and postoperative (4.6±5.7mg vs. 10.5±6 mg, p value=0.001) mean opioid consumption. However, only the reduction in postoperative opioid consumption was found to be statistically significant. Most participants (> 90%) in this study did not experience PONV and were very satisfied with their postoperative pain management. Conclusion Serratus anterior plane block reduces NRS pain scores postoperatively. It also significantly reduces postoperative opioid consumption but does not significantly reduce intraoperative opioid consumption.
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Affiliation(s)
- David K Mensah
- Anaesthesia, Intensive Care and Pain Management, Korle-Bu Teaching Hospital, Accra, GHA
| | | | - Ebenezer O Darkwa
- Department of Anaesthesia, University of Ghana Medical School, Accra, GHA
| | - Alexander Akowuah
- Anaesthesia, Intensive Care and Pain Management, Korle-Bu Teaching Hospital, Accra, GHA
| | - Owusu-Sekyere Danso
- Anaesthesia, Intensive Care and Pain Management, Korle-Bu Teaching Hospital, Accra, GHA
| | - George Aryee
- Department of Anaesthesia, University of Ghana Medical School, Accra, GHA
| | - Raymond Essuman
- Department of Anaesthesia, University of Ghana Medical School, Accra, GHA
| | - Robert Djagbletey
- Department of Anaesthesia, University of Ghana Medical School, Accra, GHA
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Singh NP, Makkar J, Bhat AD, Singh PM. Analgaesic efficacy of single-injection serratus anterior plane block for breast surgery: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Indian J Anaesth 2023; 67:343-356. [PMID: 37303883 PMCID: PMC10248900 DOI: 10.4103/ija.ija_919_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/16/2023] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
There is conflicting evidence regarding the analgaesic efficacy of single-shot serratus anterior plane block (SAP) for breast surgery. This meta-analysis aimed to evaluate the analgaesic efficacy of SAP compared with non-block care (NBC) and other regional blocks, i.e. paravertebral block (PVB) and modified pectoral nerve block (PECS block) for breast surgery. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomized controlled trials reporting the use of the SAP block in adult breast surgery. The primary outcome was postoperative oral morphine equivalent (OME) consumption for up to 24 hours. Random-effects models were used to pool results and mean difference (MD), and odds ratio (OR) was calculated for continuous and dichotomous outcomes, respectively. GRADE guidelines were used to evaluate the strength of evidence, and trial sequential analysis (TSA) was performed to provide certainty to the conclusion. Twenty-four trials enrolling 1789 patients were included. Moderate strength evidence suggested that SAP provided a significant reduction in 24-hour OME compared with NBC [MD - 24.9 mg (95% CI - 41.54, -8.25; P < 0.001, I2 = 99.68%)]. TSA ruled out the possibility of false-positive results. Subgroup analysis for the SAP demonstrated that the superficial plane approach was more effective in reducing opioid consumption than the deep approach. The odds of developing PONV were significantly lower in SAP compared to NBC. Compared with PVB and PECS, SAP block was not statistically different for 24-hour OME and time to first rescue analgaesia. Single-shot SAP reduced opioid consumption, prolonged analgaesia duration, lowered pain scores, and decreased the incidence of PONV compared to NBC. There was no statistically significant difference in the studied endpoints between SAP, PVB, and PECS blocks.
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Affiliation(s)
| | - Jeetinder Makkar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Preet M Singh
- Department of Anesthesia, Washington University, Saint Louis, MO, USA
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Li ZH, Hong WJ, Guo XL, Li XR, Jiang XY, Jiang Y, Luo SK. Serratus Plane Block in Breast Cancer Surgery: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2023; 23:e1-e13. [PMID: 36357268 DOI: 10.1016/j.clbc.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 12/27/2022]
Abstract
The serratus plane block is a regional anesthesia technique awaiting efficacy and safety evaluation in breast cancer surgery, but evidence is unclear. This meta-analysis evaluates the analgesic effectiveness of serratus plane block vis-à-vis general anesthesia and paravertebral block for breast cancer surgery. We searched for randomized controlled trials in PubMed, the Cochrane Library, and Web of Science with no language limitation, comparing the serratus plane block with multimodal analgesia or the thoracic paravertebral block in breast cancer surgery. The Hartung-Knapp-Sidik-Jonkman method in combination with a random-effects model was used to pool data. We included 12 randomized controlled trials (799 patients). Compared with multimodal analgesia, pooled outcomes favored the use of serratus plane block for effectively alleviating acute postoperative pain severity at multiple time points. The serratus plane block also resulted in decreased postoperative analgesic consumption of 28.81mg (95% confidence interval [CI]: -51.20, -6.43), decreased intraoperative fentanyl consumption of -56.46 mg (95% CI: -79.61, -33.30), increased duration of postoperative anesthesia of 243.85 min (95% CI: 104.38, 383.31), and reduced postoperative nausea and vomiting with a log relative risk of -1.07 (95% CI: -1.90, -0.24). Compared with the thoracic paravertebral block, the serratus plane block was not statically worse for all of the outcomes assessed. No adverse effects were reported. The serratus plane block effectively alleviates acute postoperative pain, reduces the rate of postoperative nausea and vomiting, and improves perioperative anesthesia outcomes in breast cancer surgery, and it may represent an alternative to thoracic paravertebral block.
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Affiliation(s)
- Zhen-Hao Li
- Jinan University, Guangzhou City, Guangdong Province, China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China
| | - Xiao-Liang Guo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China
| | - Xin-Rui Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Xuan-Yu Jiang
- Jinan University, Guangzhou City, Guangdong Province, China; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China
| | - Yu Jiang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China; Jinan University, Guangzhou City, Guangdong Province, China.
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Chai B, Yu H, Qian Y, Chen X, Zhu Z, Du J, Kang X, Zhu S. Comparison of Postoperative Pain in 70 Women with Breast Cancer Following General Anesthesia for Mastectomy with and without Serratus Anterior Plane Nerve Block. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934064. [PMID: 35125493 PMCID: PMC8832868 DOI: 10.12659/msm.934064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background This study was conducted at a single center and aimed to compare postoperative pain in 70 women with breast cancer following general anesthesia for mastectomy with and without serratus anterior plane (SAP) block. Material/Methods A total of 70 breast cancer patients who met the criteria were randomly divided into the general anesthesia combined with SAP block group (group S) and the general anesthesia only group (group G). Perioperative anesthetic drug dosage, the visual analog scale (VAS) score at different time points, and the patient’s satisfaction with analgesia 24 h after surgery, and incidence of postmastectomy pain syndrome (PMPS) were statistically analyzed in the 2 groups. Results Compared with group G, group S had lower intraoperative remifentanil dosages (P=0.003), a lower total amount of sufentanil via analgesia pump during the 24-h postoperative period (P<0.001), and lower VAS scores at 2 h, 4 h, and 8 h after surgery, and the differences were significant (P<0.05). Compared with group G, group S had a shorter first flatus time, got out of bed sooner, had a lower incidence of nausea and vomiting (P<0.05), and lower incidence of PMPS at 3 and 6 months after the operation (P<0.05). Conclusions At a single center, preoperative SAP block can significantly reduce postoperative pain after modified radical mastectomy for breast cancer.
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Affiliation(s)
- Binggao Chai
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).,Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Hongmei Yu
- Department of Breast Surgery, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Yafen Qian
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Xiaoli Chen
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Zhenqiang Zhu
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Jianlong Du
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China (mainland)
| | - Xianhui Kang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
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Long E, Maselli A, Barron S, Morgenstern M, Comer CD, Chow K, Cauley R, Lee B. Applications of Ultrasound in the Postoperative Period: A Review. J Reconstr Microsurg 2022; 38:245-253. [DOI: 10.1055/s-0041-1740959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Recent advances in ultrasound technology have further increased its potential for routine use by plastic and reconstructive surgeons.
Methods An extensive literature review was performed to determine the most common applications of ultrasound in the postoperative care of plastic and reconstructive surgery patients.
Results In contrast with other available imaging modalities, ultrasound is cost-effective, rapid to obtain, eliminates the need for ionizing radiation or intravenous contrast, and has virtually no contraindications. In addition to its diagnostic capabilities, ultrasound can also be used to facilitate treatment of common postoperative concerns conveniently at the bedside or in an office setting.
Conclusion This article presents a review of the current applications of ultrasound imaging in the postoperative care of plastic and reconstructive surgery patients, including free flap monitoring following microsurgery, diagnosis and treatment of hematoma and seroma, including those associated with BIA-ALCL, and breast implant surveillance.
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Affiliation(s)
- Emily Long
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amy Maselli
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sivana Barron
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Monica Morgenstern
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Carly D. Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kaimana Chow
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ryan Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Pain Res Manag 2021; 2021:7849623. [PMID: 34733377 PMCID: PMC8560299 DOI: 10.1155/2021/7849623] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/25/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
Objective Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery. Methods A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations. Results Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, −38.51 mg of oral morphine equivalent; 95% confidence interval (CI), −60.97 to −16.05; P < 0.01; I2 = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, −9.85 mg of oral morphine equivalent; 95% CI, −19.52 to −0.18; P=0.05; I2 = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19–0.55; P < 0.05;I2 = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), −1.23; 95% CI, −2.00 to −0.45; I2 = 92%; 2 h: SMD, −0.71; 95% CI, −1.00 to −0.41; I2 = 48%; 4 h: SMD, −1.52; 95% CI, −2.77 to −0.27; I2 = 95%; 6 h: SMD, −0.80; 95% CI, −1.51 to −0.08; I2 = 81%; 8 h: SMD, −1.12; 95% CI, −1.98 to −0.27; I2 = 92%; 12 h: SMD, −0.78; 95% CI, −1.21 to −0.35; I2 = 83%; and 24 h: SMD, −0.71; 95% CI, −1.20 to −0.23; I2 = 87%; P < 0.05 for all). Conclusion SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.
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